Provider Demographics
NPI:1811400203
Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Other - Org Name:COLERAIN PRIMARY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-356-1377
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0669
Mailing Address - Country:US
Mailing Address - Phone:252-209-0237
Mailing Address - Fax:252-209-0197
Practice Address - Street 1:109 W RIVER ST
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-9006
Practice Address - Country:US
Practice Address - Phone:252-356-2404
Practice Address - Fax:252-356-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy