Healthcare Provider Details

I. General information

NPI: 1659356525
Provider Name (Legal Business Name): BSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SOUTH MAIN ST
BLADENBORO NC
28320-0508
US

IV. Provider business mailing address

PO BOX 508
BLADENBORO NC
28320-0508
US

V. Phone/Fax

Practice location:
  • Phone: 910-863-3949
  • Fax: 910-863-3940
Mailing address:
  • Phone: 910-863-3949
  • Fax: 910-863-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number04410
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04410
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number04410
License Number StateNC

VIII. Authorized Official

Name: DR. MARK ANTHONY HESTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-863-3949