Healthcare Provider Details

I. General information

NPI: 1861936809
Provider Name (Legal Business Name): CARY LONG TERM CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PARKWAY OFFICE CT STE 105
CARY NC
27518-7424
US

IV. Provider business mailing address

135 PARKWAY OFFICE CT STE 105
CARY NC
27518-7424
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-9011
  • Fax:
Mailing address:
  • Phone: 919-977-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. PECK CHAY
Title or Position: OWNER
Credential:
Phone: 919-977-9011