Healthcare Provider Details

I. General information

NPI: 1902396732
Provider Name (Legal Business Name): OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRACE ST STE 150
ROCKY MOUNT NC
27804
US

IV. Provider business mailing address

PO BOX 2723
ROCKY MOUNT NC
27802-2723
US

V. Phone/Fax

Practice location:
  • Phone: 252-316-8220
  • Fax: 252-822-5065
Mailing address:
  • Phone: 252-212-3486
  • Fax: 252-212-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REUBEN BLACKWELL IV
Title or Position: CEO
Credential:
Phone: 252-212-3480