Provider Demographics
NPI:1720414980
Name:DURHAM COUNTY HEALTH DEPARTMENT PHARMACY
Entity Type:Organization
Organization Name:DURHAM COUNTY HEALTH DEPARTMENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING TECHNICIAN II
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LAMARR
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-560-7878
Mailing Address - Street 1:414 E MAIN ST
Mailing Address - Street 2:DURHAM COUNTY HEALTH DEPARTMENT
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701
Mailing Address - Country:US
Mailing Address - Phone:919-560-7632
Mailing Address - Fax:919-560-7873
Practice Address - Street 1:414 E MAIN ST
Practice Address - Street 2:DURHAM COUNTY HEALTH DEPARTMENT
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:919-560-7632
Practice Address - Fax:919-560-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04685333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457435349Medicaid