Healthcare Provider Details

I. General information

NPI: 1063505774
Provider Name (Legal Business Name): RICETTA RX NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4459 TARHEEL DRIVE
PINK HILL NC
28572
US

IV. Provider business mailing address

4459 TARHEEL DRIVE
PINK HILL NC
28572
US

V. Phone/Fax

Practice location:
  • Phone: 252-568-9945
  • Fax:
Mailing address:
  • Phone: 252-568-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number09308
License Number StateNC

VIII. Authorized Official

Name: DR. CHAD TERRY
Title or Position: MANAGER
Credential: PHARMD
Phone: 252-568-9945