Provider Demographics
NPI:1891940060
Name:CARLIE CS OF MEMORIAL DRIVE LLC
Entity Type:Organization
Organization Name:CARLIE CS OF MEMORIAL DRIVE LLC
Other - Org Name:CARLIE C'S PHARMACY #835
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-736-1973
Mailing Address - Street 1:1805 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2241
Mailing Address - Country:US
Mailing Address - Phone:919-736-1973
Mailing Address - Fax:919-736-1984
Practice Address - Street 1:1805 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2241
Practice Address - Country:US
Practice Address - Phone:919-736-1973
Practice Address - Fax:919-736-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3413072OtherNCPDP PROVIDER IDENTIFICATION NUMBER