Provider Demographics
NPI:1205261146
Name:CRISIS CONTROL MINISTRY INC
Entity type:Organization
Organization Name:CRISIS CONTROL MINISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIGWILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-770-1628
Mailing Address - Street 1:200 EAST 10TH STREER
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-770-1628
Mailing Address - Fax:336-770-1630
Practice Address - Street 1:200 E 10TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1512
Practice Address - Country:US
Practice Address - Phone:336-770-1628
Practice Address - Fax:336-770-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC047263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177135OtherPK