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General NPI Number Information
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NPI Number | 1003262072
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Entity Type | Organization
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Legal Business Name | HAW RIVER PHARMACY LLC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 740 E MAIN ST
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City | HAW RIVER
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State | NC
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Zip | 27258-9644
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Country | US
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Telephone | 336-578-0202
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Fax | 336-578-0266
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Provider Business Mailing Address
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Address Line | 740 E MAIN ST
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City | HAW RIVER
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State | NC
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Zip | 27258-9644
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Country | US
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Telephone | 336-578-0202
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Fax | 336-578-0266
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Authorized Official
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Title or Position | OWNER
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Name | SAMIR BHAGAT
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Credential |
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Telephone | 336-383-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13017
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License Number State | NC
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