Provider Demographics
NPI:1780729376
Name:MCCARTHY SQUARE PHARMACY, LLC
Entity type:Organization
Organization Name:MCCARTHY SQUARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-514-2900
Mailing Address - Street 1:609 MCCARTHY BLVD.
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5232
Mailing Address - Country:US
Mailing Address - Phone:252-514-2900
Mailing Address - Fax:252-514-2404
Practice Address - Street 1:609 MCCARTHY BLVD.
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5232
Practice Address - Country:US
Practice Address - Phone:252-514-2900
Practice Address - Fax:252-514-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5941332B00000X, 332BC3200X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701543Medicaid
NC1005960001Medicare ID - Type UnspecifiedMEDICARE NUMBER