Provider Demographics
NPI:1649365701
Name:LITTLETON PHARMACY INC.
Entity type:Organization
Organization Name:LITTLETON PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-586-3414
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-0607
Mailing Address - Country:US
Mailing Address - Phone:252-586-3414
Mailing Address - Fax:252-586-7377
Practice Address - Street 1:123 E. S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850
Practice Address - Country:US
Practice Address - Phone:252-586-3414
Practice Address - Fax:252-586-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC033983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700630Medicaid
NC0425280Medicaid
NC0425280Medicaid