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General NPI Number Information
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NPI Number | 1093811093
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Entity Type | Organization
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Legal Business Name | CUSTOM CAR PHARMACY, INC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2500 BATTLEGROUND AVE STE C
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City | GREENSBORO
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State | NC
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Zip | 27408-4030
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Country | US
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Telephone | 336-289-0074
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Fax | 336-286-6696
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Provider Business Mailing Address
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Address Line | 2500 BATTLEGROUND AVE STE C
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City | GREENSBORO
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State | NC
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Zip | 27408-4030
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Country | US
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Telephone | 336-289-0074
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Fax | 336-286-6696
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH ANNE MEADE KING
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Credential | PHARMD.
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Telephone | 336-289-9969
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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 | 07732
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License Number State | NC
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