Provider Demographics
NPI:1912147455
Name:HOSPICE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:HOSPICE PHARMACY SERVICES INC
Other - Org Name:ANDREWS APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAMER
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:336-723-1679
Mailing Address - Street 1:3072 TRENWEST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3216
Mailing Address - Country:US
Mailing Address - Phone:336-723-1679
Mailing Address - Fax:336-723-1670
Practice Address - Street 1:3072 TRENWEST DR STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3219
Practice Address - Country:US
Practice Address - Phone:336-723-1679
Practice Address - Fax:336-723-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02140015493336C0003X
NC102263336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0345173Medicaid
2120279OtherPK