Provider Demographics
NPI:1457344988
Name:HALSEY DRUG LLC
Entity Type:Organization
Organization Name:HALSEY DRUG LLC
Other - Org Name:WARRENSVILLE DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-264-3055
Mailing Address - Street 1:345 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5009
Mailing Address - Country:US
Mailing Address - Phone:828-355-3365
Mailing Address - Fax:828-264-0543
Practice Address - Street 1:5121 NC HIGHWAY 88 WEST
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28693-9209
Practice Address - Country:US
Practice Address - Phone:336-384-3900
Practice Address - Fax:336-384-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC04679333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0055129Medicaid
VA008515867Medicaid
3423770OtherBNDD NUMBER
VA008515867Medicaid