Healthcare Provider Details

I. General information

NPI: 1275579294
Provider Name (Legal Business Name): COUNTY OF CLEVELAND NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S POST RD
SHELBY NC
28152-6227
US

IV. Provider business mailing address

200 S POST RD
SHELBY NC
28152
US

V. Phone/Fax

Practice location:
  • Phone: 980-484-5164
  • Fax: 800-835-4512
Mailing address:
  • Phone: 980-484-5164
  • Fax: 980-484-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number04794
License Number StateNC

VIII. Authorized Official

Name: TIFFANY HANSEN
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 980-484-5200