Provider Demographics
NPI:1831136761
Name:COMMUNITY PHARMACY, INC.
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY, INC.
Other - Org Name:COMMUNITY PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:252-726-7787
Mailing Address - Street 1:3302 BRIDGES ST
Mailing Address - Street 2:STE A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2983
Mailing Address - Country:US
Mailing Address - Phone:252-726-7787
Mailing Address - Fax:252-247-7795
Practice Address - Street 1:3302 BRIDGES ST
Practice Address - Street 2:STE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2983
Practice Address - Country:US
Practice Address - Phone:252-726-7787
Practice Address - Fax:252-247-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BD1200X, 332BX2000X, 333600000X, 3336C0004X
NC090273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068167OtherPK
NC0165430Medicaid
5455450001Medicare NSC