Healthcare Provider Details

I. General information

NPI: 1831136761
Provider Name (Legal Business Name): COMMUNITY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 BRIDGES ST STE A
MOREHEAD CITY NC
28557-2983
US

IV. Provider business mailing address

3302 BRIDGES ST STE A
MOREHEAD CITY NC
28557-2983
US

V. Phone/Fax

Practice location:
  • Phone: 252-726-7787
  • Fax: 252-247-7795
Mailing address:
  • Phone: 252-726-7787
  • Fax: 252-247-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09027
License Number StateNC

VIII. Authorized Official

Name: MARK LAROQUE
Title or Position: PRESIDENT
Credential: BS PHARMACY
Phone: 252-726-7787