Provider Demographics
NPI:1831574367
Name:FAMILY CARE PHARMACY OF JACKSONVILLE
Entity type:Organization
Organization Name:FAMILY CARE PHARMACY OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-353-5050
Mailing Address - Street 1:114 MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6328
Mailing Address - Country:US
Mailing Address - Phone:910-353-5050
Mailing Address - Fax:910-238-4659
Practice Address - Street 1:114 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-5050
Practice Address - Fax:910-238-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10242332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705209Medicaid
NC0675695Medicaid
NC0675695Medicaid