Healthcare Provider Details

I. General information

NPI: 1215942834
Provider Name (Legal Business Name): SEVEN LAKES PRESCRIPTION SHOPPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAC DOUGALL DR
WEST END NC
27376-9342
US

IV. Provider business mailing address

120 MAC DOUGALL DR
WEST END NC
27376-9342
US

V. Phone/Fax

Practice location:
  • Phone: 910-673-7467
  • Fax: 910-673-3595
Mailing address:
  • Phone: 910-673-7467
  • Fax: 910-673-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07289
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BARRETT
Title or Position: OWNER
Credential: PHARMD
Phone: 910-673-7467