Provider Demographics
NPI:1942231535
Name:MEDICAL CENTER PHARMACY OF CHERRYVILLE INC
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY OF CHERRYVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:704-435-3263
Mailing Address - Street 1:607 E ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021
Mailing Address - Country:US
Mailing Address - Phone:704-435-3263
Mailing Address - Fax:704-435-9499
Practice Address - Street 1:607 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021
Practice Address - Country:US
Practice Address - Phone:704-435-3263
Practice Address - Fax:704-435-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02151333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02151OtherBOARD OF PHARMACY
NC0365288Medicaid
NC7702072OtherDME MEDICAID
NCAM3197589OtherDEA
0775190001Medicare NSC