Provider Demographics
NPI:1831721364
Name:SEVEN LAKES PRESCRIPTION SHOPPE, INC LONG TERM CARE
Entity type:Organization
Organization Name:SEVEN LAKES PRESCRIPTION SHOPPE, INC LONG TERM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-673-7467
Mailing Address - Street 1:120 MAC DOUGALL DR
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9342
Mailing Address - Country:US
Mailing Address - Phone:910-673-7467
Mailing Address - Fax:910-673-3595
Practice Address - Street 1:120 MAC DOUGALL DR
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-9342
Practice Address - Country:US
Practice Address - Phone:910-673-7467
Practice Address - Fax:910-673-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0635808Medicaid