Healthcare Provider Details

I. General information

NPI: 1528359874
Provider Name (Legal Business Name): OFFICE MEDS MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 WAKE FOREST RD STE 112-B
RALEIGH NC
27609-7874
US

IV. Provider business mailing address

PO BOX 90216
RALEIGH NC
27675-0216
US

V. Phone/Fax

Practice location:
  • Phone: 919-865-9993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11012
License Number StateNC

VIII. Authorized Official

Name: TONY GURLEY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 919-215-0240