Provider Demographics
NPI:1821087990
Name:MEDICAL ARTS PHARMACY OF LUMBERTON INC
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY OF LUMBERTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-3870
Mailing Address - Street 1:1550 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4206
Mailing Address - Country:US
Mailing Address - Phone:910-739-3370
Mailing Address - Fax:910-739-0093
Practice Address - Street 1:1550 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4206
Practice Address - Country:US
Practice Address - Phone:910-739-3370
Practice Address - Fax:910-739-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05283333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408564OtherNABP
NC7701167OtherDMCAID
NC00785550Medicaid
NC7701167OtherDMCAID