Provider Demographics
NPI:1184960528
Name:LEAR ENTERPRISES INC
Entity type:Organization
Organization Name:LEAR ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-321-0027
Mailing Address - Street 1:8145 ARDREY KELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5720
Mailing Address - Country:US
Mailing Address - Phone:704-321-0027
Mailing Address - Fax:704-321-0067
Practice Address - Street 1:8145 ARDREY KELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5720
Practice Address - Country:US
Practice Address - Phone:704-321-0027
Practice Address - Fax:704-321-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10154333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0602301Medicaid
NC7705159OtherMEDICAID DME
NC2724920AOtherMEDICARE MASS IMMUNIZER
NC2724920AOtherMEDICARE MASS IMMUNIZER