Healthcare Provider Details

I. General information

NPI: 1003262072
Provider Name (Legal Business Name): HAW RIVER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E MAIN ST
HAW RIVER NC
27258-9644
US

IV. Provider business mailing address

740 E MAIN ST
HAW RIVER NC
27258-9644
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-0202
  • Fax: 336-578-0266
Mailing address:
  • Phone: 336-578-0202
  • Fax: 336-578-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13017
License Number StateNC

VIII. Authorized Official

Name: SAMIR BHAGAT
Title or Position: OWNER
Credential:
Phone: 336-383-9902