Provider Demographics
NPI:1700247970
Name:PHARMBLUE NORTH CAROLINA LLC
Entity type:Organization
Organization Name:PHARMBLUE NORTH CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-779-4720
Mailing Address - Street 1:40 PENNWOOD PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-6512
Mailing Address - Country:US
Mailing Address - Phone:724-779-4720
Mailing Address - Fax:
Practice Address - Street 1:300 N GRACE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5345
Practice Address - Country:US
Practice Address - Phone:800-609-0822
Practice Address - Fax:844-873-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy