Provider Demographics
NPI:1790917375
Name:HEALTH PARK PHARMACY, LLC
Entity Type:Organization
Organization Name:HEALTH PARK PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-835-0457
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 227
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-835-0457
Mailing Address - Fax:919-835-0459
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 227
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-847-7645
Practice Address - Fax:919-847-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy