Healthcare Provider Details

I. General information

NPI: 1942231535
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY OF CHERRYVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E ACADEMY ST
CHERRYVILLE NC
28021
US

IV. Provider business mailing address

607 E ACADEMY ST
CHERRYVILLE NC
28021
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-3263
  • Fax: 704-435-9499
Mailing address:
  • Phone: 704-435-3263
  • Fax: 704-435-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02151
License Number StateNC

VIII. Authorized Official

Name: MR. BRIAN DAVID KISER
Title or Position: OFFICE MANAGER
Credential: OFFICE MANAGER
Phone: 704-435-3263