Healthcare Provider Details

I. General information

NPI: 1841211620
Provider Name (Legal Business Name): HCC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S MAIN ST
RAEFORD NC
28376-3223
US

IV. Provider business mailing address

402 S MAIN ST
RAEFORD NC
28376-3223
US

V. Phone/Fax

Practice location:
  • Phone: 910-875-4831
  • Fax: 910-875-9658
Mailing address:
  • Phone: 910-875-4831
  • Fax: 910-875-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07835
License Number StateNC

VIII. Authorized Official

Name: MR. TIMOTHY LOCKLEAR
Title or Position: VP OF CORPORATE AFFAIRS
Credential: MBA
Phone: 910-875-1032