=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285665521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAKEMED OP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 04/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 NEW BERN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-350-8195
-----------------------------------------------------
Fax | 919-350-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 NEW BERN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-350-8195
-----------------------------------------------------
Fax | 919-350-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE, INTERIM CFO
-----------------------------------------------------
Name | STEPHANIE T SESSOMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-350-0527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 03140
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------