Healthcare Provider Details

I. General information

NPI: 1609024595
Provider Name (Legal Business Name): GPN EXPRESS ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14057 US HIGHWAY 17 N SUITE 100
HAMPSTEAD NC
28443-3770
US

IV. Provider business mailing address

14057 US HIGHWAY 17 N SUITE 100
HAMPSTEAD NC
28443-3770
US

V. Phone/Fax

Practice location:
  • Phone: 910-319-6050
  • Fax: 910-319-6045
Mailing address:
  • Phone: 910-319-6050
  • Fax: 910-319-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10151
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NHAT QUY TRINH
Title or Position: MEMBER
Credential:
Phone: 910-319-6050