Healthcare Provider Details

I. General information

NPI: 1609131283
Provider Name (Legal Business Name): HEALTHWISE PHARMACY OF GREENVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S WM HOOKER DR APT B
HOOKERTON NC
28538-7188
US

IV. Provider business mailing address

516-B SOUTH WILLIAM HOOKER DRIVE
HOOKERTON NC
28538
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-0154
  • Fax: 252-747-0153
Mailing address:
  • Phone: 252-747-0154
  • Fax: 252-747-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11309
License Number StateNC

VIII. Authorized Official

Name: MARCIE PARKER
Title or Position: CORPORATION SECRETARY
Credential:
Phone: 252-752-0338