Provider Demographics
NPI:1013218312
Name:EGB ENTERJPRISES
Entity Type:Organization
Organization Name:EGB ENTERJPRISES
Other - Org Name:VILLAGE PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-646-3400
Mailing Address - Street 1:108 E HWY 7476
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450
Mailing Address - Country:US
Mailing Address - Phone:910-646-3400
Mailing Address - Fax:910-646-4056
Practice Address - Street 1:108 E HWY 7476
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450
Practice Address - Country:US
Practice Address - Phone:910-646-3400
Practice Address - Fax:910-646-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC039913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245530Medicaid
0608230001Medicare Oscar/Certification
NC0608230001Medicare Oscar/Certification