Provider Demographics
NPI:1821143173
Name:CARRBORO FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:CARRBORO FAMILY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-933-7629
Mailing Address - Street 1:104 HIGHWAY 54 WEST BYPASS UNIT J
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510
Mailing Address - Country:US
Mailing Address - Phone:919-933-7629
Mailing Address - Fax:919-933-7631
Practice Address - Street 1:104 HIGHWAY 54 WEST BYPASS UNIT J
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510
Practice Address - Country:US
Practice Address - Phone:919-933-7629
Practice Address - Fax:919-933-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC077003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0685503Medicaid