Healthcare Provider Details

I. General information

NPI: 1437448701
Provider Name (Legal Business Name): ROBINHOOD FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 ROBINHOOD RD
WINSTON SALEM NC
27106-4702
US

IV. Provider business mailing address

3424 ROBINHOOD RD
WINSTON SALEM NC
27106-4702
US

V. Phone/Fax

Practice location:
  • Phone: 336-283-9355
  • Fax: 336-283-9357
Mailing address:
  • Phone: 336-283-9355
  • Fax: 336-283-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10989
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier2129790
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier0347815
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: GUNAR STOWERS
Title or Position: PHARMACIST MANAGER/OWNER
Credential:
Phone: 336-283-9355