Healthcare Provider Details

I. General information

NPI: 1245521020
Provider Name (Legal Business Name): EASTERN CAROLINA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
BENSON NC
27504-1177
US

IV. Provider business mailing address

1 MEDICAL DR
BENSON NC
27504-1177
US

V. Phone/Fax

Practice location:
  • Phone: 919-207-1027
  • Fax: 919-207-1032
Mailing address:
  • Phone: 919-207-1027
  • Fax: 919-207-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10997
License Number StateNC

VIII. Authorized Official

Name: DR. PANKAJ KIRTIKANT VYAS
Title or Position: OWNER
Credential:
Phone: 919-897-5787