Healthcare Provider Details

I. General information

NPI: 1134838592
Provider Name (Legal Business Name): MEDSMART PHARMACY #4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 NC HIGHWAY 87 S STE 100
FAYETTEVILLE NC
28306-3424
US

IV. Provider business mailing address

217 W BROAD ST
SAINT PAULS NC
28384-1533
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-3466
  • Fax: 910-483-0366
Mailing address:
  • Phone: 910-865-4135
  • Fax: 910-865-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH WILLIAMS
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 910-734-3397