Provider Demographics
NPI:1134838592
Name:MEDSMART PHARMACY #4 LLC
Entity type:Organization
Organization Name:MEDSMART PHARMACY #4 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-734-3397
Mailing Address - Street 1:217 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1533
Mailing Address - Country:US
Mailing Address - Phone:910-865-4135
Mailing Address - Fax:910-865-3000
Practice Address - Street 1:5106 NC HIGHWAY 87 S STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3424
Practice Address - Country:US
Practice Address - Phone:910-483-3466
Practice Address - Fax:910-483-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy