Healthcare Provider Details

I. General information

NPI: 1922364298
Provider Name (Legal Business Name): NATURAL SLEEP STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 NW CARY PKWY STE 112
CARY NC
27513-8432
US

IV. Provider business mailing address

165 NE BROAD ST
SOUTHERN PINES NC
28387-5525
US

V. Phone/Fax

Practice location:
  • Phone: 910-691-1022
  • Fax: 910-579-6990
Mailing address:
  • Phone: 910-246-9355
  • Fax: 910-246-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11273
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3459991
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: TREY WATERS
Title or Position: PRESIDENT
Credential:
Phone: 910-691-1022