Healthcare Provider Details

I. General information

NPI: 1639541253
Provider Name (Legal Business Name): GREATER HICKORY COOPERATIVE CHRISTIAN MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 1ST AVE SE
HICKORY NC
28602-3003
US

IV. Provider business mailing address

31 1ST AVE SE
HICKORY NC
28602-3003
US

V. Phone/Fax

Practice location:
  • Phone: 828-327-0979
  • Fax: 828-327-2187
Mailing address:
  • Phone: 828-327-0979
  • Fax: 828-327-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05520
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARVIN ALLEN
Title or Position: PHARMACIST
Credential:
Phone: 980-322-4110