Provider Demographics
NPI:1902846413
Name:RICHARD A BLOOMFIELD & PHILIP R BLOOMFIELD
Entity Type:Organization
Organization Name:RICHARD A BLOOMFIELD & PHILIP R BLOOMFIELD
Other - Org Name:FAMILY PHARMACY & HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BLOOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-223-5054
Mailing Address - Street 1:338 HOWARD BLVD
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-7928
Mailing Address - Country:US
Mailing Address - Phone:252-223-3291
Mailing Address - Fax:
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7928
Practice Address - Country:US
Practice Address - Phone:252-223-3291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0165225Medicaid
NC0439130001Medicare NSC