Provider Demographics
NPI:1013064476
Name:SALEMBURG PHARMACY INC
Entity Type:Organization
Organization Name:SALEMBURG PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS BUSINESS MANAGER PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECH
Authorized Official - Phone:910-525-4490
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:SALEMBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28385
Mailing Address - Country:US
Mailing Address - Phone:910-525-4490
Mailing Address - Fax:910-525-3346
Practice Address - Street 1:112 WEST COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SALEMBURG
Practice Address - State:NC
Practice Address - Zip Code:28385
Practice Address - Country:US
Practice Address - Phone:910-525-4490
Practice Address - Fax:910-525-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04046332B00000X, 332BP3500X, 333600000X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703763Medicaid
NC0825224Medicaid
NC0825224Medicaid