Provider Demographics
NPI:1982709309
Name:MEDEXPRESS PHARMACY, LTD.
Entity Type:Organization
Organization Name:MEDEXPRESS PHARMACY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARM. OPS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-236-1549
Mailing Address - Street 1:1431 W. INNES STREET
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145
Mailing Address - Country:US
Mailing Address - Phone:800-633-3977
Mailing Address - Fax:800-615-0075
Practice Address - Street 1:1431 W. INNES STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28145
Practice Address - Country:US
Practice Address - Phone:800-633-3977
Practice Address - Fax:800-615-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07849333600000X
NC12033333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3439278OtherNCPDP NUMBER
NC0805739Medicaid
VA010071267Medicaid
SC1982709309Medicaid