Healthcare Provider Details

I. General information

NPI: 1982898359
Provider Name (Legal Business Name): NORTH IREDELL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 W MEMORIAL HWY
HARMONY NC
28634-9352
US

IV. Provider business mailing address

837 N CENTER ST
STATESVILLE NC
28677-3222
US

V. Phone/Fax

Practice location:
  • Phone: 704-539-4727
  • Fax: 704-539-5127
Mailing address:
  • Phone: 704-872-0880
  • Fax: 704-871-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09894
License Number StateNC

VIII. Authorized Official

Name: LARRY MARLIN
Title or Position: OWNER
Credential:
Phone: 704-872-0880