Provider Demographics
NPI:1265799894
Name:MIDTOWN PHARMACY, LLC
Entity type:Organization
Organization Name:MIDTOWN PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRANDISON
Authorized Official - Last Name:COCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-446-0099
Mailing Address - Street 1:941 CENTER CREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-8002
Mailing Address - Country:US
Mailing Address - Phone:336-446-0099
Mailing Address - Fax:336-446-0094
Practice Address - Street 1:941 CENTER CREST DR STE A
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-8002
Practice Address - Country:US
Practice Address - Phone:336-446-0099
Practice Address - Fax:336-446-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC083353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy