Healthcare Provider Details

I. General information

NPI: 1104909142
Provider Name (Legal Business Name): HAMPSTEAD FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15489 HWY 17 N UNIT 2
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

15489 HWY 17 N UNIT 2
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-1077
  • Fax: 910-270-2711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7703557
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number08083
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANN WILSON
Title or Position: PHCY MANAGER
Credential:
Phone: 910-270-1077