MEDICARE: PICKLED HERRING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	08294	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2069081	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053356360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICKLED HERRING INC

Provider Business Mailing Address
First Line	:	517 LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:	910-276-1154
Fax Number	:	910-276-0082

Provider Business Practice Location Address
First Line	:	517 LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:	910-276-1154
Fax Number	:	910-276-0082

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES HERRING
Credential	:	PHARMD
Telephone Number	:	910-276-1154

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/05/2021

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Directions to “PICKLED HERRING INC ” Practice Location

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