Provider Demographics
NPI:1841211620
Name:HCC PHARMACY
Entity Type:Organization
Organization Name:HCC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CORPORATE AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-875-1032
Mailing Address - Street 1:402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3223
Mailing Address - Country:US
Mailing Address - Phone:910-875-4831
Mailing Address - Fax:910-875-9658
Practice Address - Street 1:402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3223
Practice Address - Country:US
Practice Address - Phone:910-875-4831
Practice Address - Fax:910-875-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC078353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0475078Medicaid
NC0475110Medicaid
NC7703001Medicaid
3439189OtherOTHER ID NUMBER
NC7703001Medicaid