Provider Demographics
NPI:1982898359
Name:NORTH IREDELL PHARMACY, INC
Entity Type:Organization
Organization Name:NORTH IREDELL PHARMACY, INC
Other - Org Name:NORTH IREDELL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-872-0880
Mailing Address - Street 1:837 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-872-0880
Mailing Address - Fax:704-871-0440
Practice Address - Street 1:979 W MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:NC
Practice Address - Zip Code:28634-9352
Practice Address - Country:US
Practice Address - Phone:704-539-4727
Practice Address - Fax:704-539-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC098943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3409047OtherNCPDP PROVIDER IDENTIFICATION NUMBER