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General NPI Number Information
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NPI Number | 1174650998
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Entity Type | Organization
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Legal Business Name | NEW MASSEY HILL PHARMACY LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 1072 SOUTHERN AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-1766
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Country | US
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Telephone | 910-484-0150
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Fax | 910-484-3270
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Provider Business Mailing Address
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Address Line | 1072 SOUTHERN AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-1766
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Country | US
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Telephone | 910-484-0150
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Fax | 910-484-3270
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MR. SRIDHAR GOTTIPATI
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Credential | RPH
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Telephone | 910-484-0159
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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 | 10320
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License Number State | NC
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