Provider Demographics
NPI:1740545888
Name:RXCAROLINA
Entity type:Organization
Organization Name:RXCAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-632-4141
Mailing Address - Street 1:5710 W GATE CITY BLVD
Mailing Address - Street 2:Z
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7061
Mailing Address - Country:US
Mailing Address - Phone:336-632-4141
Mailing Address - Fax:336-632-4135
Practice Address - Street 1:5710 W GATE CITY BLVD
Practice Address - Street 2:Z
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7061
Practice Address - Country:US
Practice Address - Phone:336-632-4141
Practice Address - Fax:336-632-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-04
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC112753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418664Medicaid
2135896OtherPK