Provider Demographics
NPI:1780964031
Name:COMMUNITY PHARMACY OF LINCOLNTON, LLC
Entity type:Organization
Organization Name:COMMUNITY PHARMACY OF LINCOLNTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-735-2556
Mailing Address - Street 1:626 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3712
Mailing Address - Country:US
Mailing Address - Phone:704-735-2556
Mailing Address - Fax:704-735-1656
Practice Address - Street 1:626 CENTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3712
Practice Address - Country:US
Practice Address - Phone:704-735-2556
Practice Address - Fax:704-735-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC055368Medicaid