Provider Demographics
NPI:1972833630
Name:CREECH DRUG COMPANY INC
Entity Type:Organization
Organization Name:CREECH DRUG COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CREECH
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-965-2316
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-0535
Mailing Address - Country:US
Mailing Address - Phone:919-965-2316
Mailing Address - Fax:919-965-2400
Practice Address - Street 1:126 N RAIFORD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-2833
Practice Address - Country:US
Practice Address - Phone:919-965-2316
Practice Address - Fax:919-965-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0515015Medicaid
NC0515015Medicaid