Provider Demographics
NPI:1982776514
Name:MEDICAP PHARMACY OF CATAWBA,LLC
Entity Type:Organization
Organization Name:MEDICAP PHARMACY OF CATAWBA,LLC
Other - Org Name:HEALTHSMART PHARMACY-CATAWBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING R.PH./ PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-241-2422
Mailing Address - Street 1:201 2ND AVE SW
Mailing Address - Street 2:P.O. BOX 447
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-0447
Mailing Address - Country:US
Mailing Address - Phone:828-241-2422
Mailing Address - Fax:828-241-9810
Practice Address - Street 1:201 2ND ST SW
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-8811
Practice Address - Country:US
Practice Address - Phone:828-241-2422
Practice Address - Fax:828-241-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0185629Medicaid
3421182OtherOTHER ID NUMBER
NC2800008Medicare PIN
NC0185629Medicaid