Provider Demographics
NPI:1760734362
Name:ERWIN IGA, INC.
Entity Type:Organization
Organization Name:ERWIN IGA, INC.
Other - Org Name:CARLIE C'S PHARMACY #885
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-826-8942
Mailing Address - Street 1:801 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2635
Mailing Address - Country:US
Mailing Address - Phone:910-897-5014
Mailing Address - Fax:910-897-2801
Practice Address - Street 1:801 S 13TH ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2635
Practice Address - Country:US
Practice Address - Phone:910-897-5014
Practice Address - Fax:910-897-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10599OtherNCBOP PERMIT