Provider Demographics
NPI:1932188836
Name:COMMUNITY PHARMACY OF BETHLEHEM INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF BETHLEHEM INC
Other - Org Name:BETHLEHEM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-3287
Mailing Address - Street 1:9471 NC HIGHWAY 127
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8394
Mailing Address - Country:US
Mailing Address - Phone:828-495-8258
Mailing Address - Fax:828-495-8260
Practice Address - Street 1:9471 NC HIGHWAY 127
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-8394
Practice Address - Country:US
Practice Address - Phone:828-495-8258
Practice Address - Fax:828-495-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0025164Medicaid
2130235OtherPK
NC7705417Medicaid
NC0025164Medicaid