Healthcare Provider Details

I. General information

NPI: 1740332097
Provider Name (Legal Business Name): CHERRY HOSPITAL STATE OF NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WEST ASH STREET
GOLDSBORO NC
27530
US

IV. Provider business mailing address

1401 W ASH ST
GOLDSBORO NC
27530-1078
US

V. Phone/Fax

Practice location:
  • Phone: 919-947-7408
  • Fax: 919-705-5182
Mailing address:
  • Phone: 919-947-8160
  • Fax: 919-705-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02656
License Number StateNC

VIII. Authorized Official

Name: DERRICK C LLOYD
Title or Position: BUDGET OFFICER
Credential:
Phone: 919-947-8357