Provider Demographics
NPI:1801410295
Name:SCENIC PHARMACY, INC
Entity type:Organization
Organization Name:SCENIC PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-403-0565
Mailing Address - Street 1:113 SCENIC OUTLET LN STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9978
Mailing Address - Country:US
Mailing Address - Phone:336-352-5900
Mailing Address - Fax:336-352-5901
Practice Address - Street 1:113 SCENIC OUTLET LN STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-9978
Practice Address - Country:US
Practice Address - Phone:336-352-5900
Practice Address - Fax:336-352-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy