Provider Demographics
NPI:1942377668
Name:HEALTH FIRST PHARMACY OF WAKE FOREST LLC
Entity Type:Organization
Organization Name:HEALTH FIRST PHARMACY OF WAKE FOREST LLC
Other - Org Name:HEALTHSMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-569-0500
Mailing Address - Street 1:2001 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1649
Mailing Address - Country:US
Mailing Address - Phone:919-569-0500
Mailing Address - Fax:919-556-4288
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1649
Practice Address - Country:US
Practice Address - Phone:919-569-0500
Practice Address - Fax:919-556-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC0887912/31/20163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704226Medicaid
NC0920745Medicaid
2067558OtherPK
NC0920745Medicaid
2801166Medicare PIN