Healthcare Provider Details

I. General information

NPI: 1033228911
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY INC OF HICKORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N CENTER ST
HICKORY NC
28601-6215
US

IV. Provider business mailing address

PO BOX 1627
HICKORY NC
28603-1627
US

V. Phone/Fax

Practice location:
  • Phone: 822-322-7717
  • Fax: 828-322-1114
Mailing address:
  • Phone: 828-322-7717
  • Fax: 828-322-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01284
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01284
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number01284
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number01284
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number01284
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01284
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOAN M BASTON
Title or Position: DO
Credential:
Phone: 828-322-7717