Healthcare Provider Details

I. General information

NPI: 1821157827
Provider Name (Legal Business Name): MCCARTHY SQUARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MCCARTHY BLVD
NEW BERN NC
28562-5232
US

IV. Provider business mailing address

609 MCCARTHY BLVD
NEW BERN NC
28562-5232
US

V. Phone/Fax

Practice location:
  • Phone: 252-514-2900
  • Fax: 252-514-2404
Mailing address:
  • Phone: 252-514-2900
  • Fax: 252-514-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05941
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE DAVIS
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 252-514-2900