Healthcare Provider Details

I. General information

NPI: 1609531367
Provider Name (Legal Business Name): ROYAL CROWN RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 11/07/2021
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 E 10TH STREET EXT STE D
GREENVILLE NC
27858-0838
US

IV. Provider business mailing address

2120 E FIRE TOWER RD SUITE 107- 1123
GREENVILLE NC
27858-8013
US

V. Phone/Fax

Practice location:
  • Phone: 252-327-9063
  • Fax: 855-684-1959
Mailing address:
  • Phone: 252-327-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: VERONICA CARR
Title or Position: OWNER
Credential:
Phone: 252-327-9063