Provider Demographics
NPI:1477611663
Name:MEDICAL CENTER PHARMACY OF WILMINGTON, LLC
Entity type:Organization
Organization Name:MEDICAL CENTER PHARMACY OF WILMINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/MANAGER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-808-9838
Mailing Address - Street 1:912 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-8016
Mailing Address - Country:US
Mailing Address - Phone:910-763-1896
Mailing Address - Fax:910-763-1709
Practice Address - Street 1:912 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8016
Practice Address - Country:US
Practice Address - Phone:910-763-1896
Practice Address - Fax:910-763-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700605Medicaid
NC0405KOtherBCBS NC PROVIDER #
NC0655753Medicaid
NC0397990001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER