Provider Demographics
NPI:1922364298
Name:NATURAL SLEEP STORE LLC
Entity Type:Organization
Organization Name:NATURAL SLEEP STORE LLC
Other - Org Name:SPECIALTY PHARMACY OF CARY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-691-1022
Mailing Address - Street 1:165 NE BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5525
Mailing Address - Country:US
Mailing Address - Phone:910-246-9355
Mailing Address - Fax:910-246-1755
Practice Address - Street 1:3750 NW CARY PKWY STE 112
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8432
Practice Address - Country:US
Practice Address - Phone:910-691-1022
Practice Address - Fax:910-579-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112733336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3459991OtherNCPDP PROVIDER IDENTIFICATION NUMBER