Provider Demographics
NPI:1952441826
Name:CANADAY CANADAY PTNRS
Entity Type:Organization
Organization Name:CANADAY CANADAY PTNRS
Other - Org Name:FOUR OAKS DRUG CO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MERWIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CANADAY
Authorized Official - Suffix:
Authorized Official - Credentials:REG PHARMACIST
Authorized Official - Phone:919-963-2155
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:200 MAIN STREET
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-0068
Mailing Address - Country:US
Mailing Address - Phone:919-963-2155
Mailing Address - Fax:919-963-2155
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-0068
Practice Address - Country:US
Practice Address - Phone:919-963-2155
Practice Address - Fax:919-963-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02821183500000X
NC03051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3406231OtherNABP
NC0515049Medicaid