Provider Demographics
NPI:1649546094
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCPS
Authorized Official - Phone:336-713-3421
Mailing Address - Street 1:2311 LEWISVILLE-CLEMMONS ROAD
Mailing Address - Street 2:MEDICAL PLAZA-CLEMMONS PHARMACY
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8905
Mailing Address - Country:US
Mailing Address - Phone:336-713-0900
Mailing Address - Fax:
Practice Address - Street 1:2311 LEWISVILLE-CLEMMONS ROAD
Practice Address - Street 2:MEDICAL PLAZA-CLEMMONS PHARMACY
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8905
Practice Address - Country:US
Practice Address - Phone:336-713-0900
Practice Address - Fax:336-713-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333600000X, 3336C0003X, 3336C0003X
NC112923336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0347923Medicaid
NC11292OtherNCBOP
NC11292OtherNCBOP
NC6571OtherTHE JOINT COMMISSION
NCFM3326673OtherDEA
NCH0011OtherDEPARTMENT OF HEALTH AND HUMAN SERVICES
NC0347923Medicaid