Provider Demographics
NPI:1942257662
Name:HARDY-WHITE PHARMACIES, INC.
Entity Type:Organization
Organization Name:HARDY-WHITE PHARMACIES, INC.
Other - Org Name:KEEVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-835-0457
Mailing Address - Street 1:PO BOX 6726
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27628-6726
Mailing Address - Country:US
Mailing Address - Phone:919-835-0457
Mailing Address - Fax:
Practice Address - Street 1:102 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4406
Practice Address - Country:US
Practice Address - Phone:704-735-9072
Practice Address - Fax:704-735-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7691332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703315Medicaid
NC3408398OtherNCPDP NUMBER
NC0555292Medicaid
4013970002Medicare NSC
NC2800013Medicare PIN