Provider Demographics
NPI:1871508416
Name:DENVER PHCY OF LINCOLN CNTY INC
Entity Type:Organization
Organization Name:DENVER PHCY OF LINCOLN CNTY INC
Other - Org Name:DENVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-873-7612
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 N HWY 16
Practice Address - Street 2:STE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-483-5571
Practice Address - Fax:704-482-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC071263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3415305OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0555227Medicaid
3870440001Medicare ID - Type Unspecified