Provider Demographics
NPI:1700983640
Name:HOPE MILLS PHARMACY LLC
Entity Type:Organization
Organization Name:HOPE MILLS PHARMACY LLC
Other - Org Name:CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-865-4135
Mailing Address - Street 1:217 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ST PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1533
Mailing Address - Country:US
Mailing Address - Phone:910-865-4135
Mailing Address - Fax:910-865-3000
Practice Address - Street 1:3736 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1959
Practice Address - Country:US
Practice Address - Phone:910-425-6106
Practice Address - Fax:910-425-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00859333600000X
3336C0003X
NC134363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3407726OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0265025Medicaid