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General NPI Number Information
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NPI Number | 1013015049
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Entity Type | Organization
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Legal Business Name | EXTENSIVE PHARMACEUTICAL SERVICES, INC.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 306 N QUEEN ST
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City | KINSTON
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State | NC
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Zip | 28501-4932
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Country | US
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Telephone | 252-527-1593
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Fax | 252-527-1893
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Provider Business Mailing Address
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Address Line | 306 N QUEEN ST
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City | KINSTON
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State | NC
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Zip | 28501-4932
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Country | US
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Telephone | 252-527-1593
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Fax | 252-527-1893
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Authorized Official
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Title or Position | MANAGER
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Name | GLENN WHITLEY
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Credential | PHARMD
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Telephone | 252-527-1593
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 10268
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License Number State | NC
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