Healthcare Provider Details

I. General information

NPI: 1871899617
Provider Name (Legal Business Name): ANDERSON CREEK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6779 OVERHILLS RD
SPRING LAKE NC
28390-8873
US

IV. Provider business mailing address

PO BOX 470
LINDEN NC
28356-0470
US

V. Phone/Fax

Practice location:
  • Phone: 910-497-6337
  • Fax: 910-497-0590
Mailing address:
  • Phone: 910-497-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10928
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0435545
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier2128603
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: ANGELA FIPPS
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 910-497-6337