Healthcare Provider Details

I. General information

NPI: 1679638167
Provider Name (Legal Business Name): HEALTH PARK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK SUITE 227
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

8300 HEALTH PARK SUITE 227
RALEIGH NC
27615-4731
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-7645
  • Fax: 919-847-7641
Mailing address:
  • Phone: 919-847-7645
  • Fax: 919-857-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11200
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9307
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY STEVEN ADKINS II
Title or Position: OWNER/MANAGER
Credential:
Phone: 919-847-7645