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General NPI Number Information
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NPI Number | 1326146135
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Entity Type | Organization
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Legal Business Name | GLEN RAVEN PHARMACY, INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1902 W WEBB AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-1062
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Country | US
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Telephone | 336-584-3736
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Fax | 336-584-3735
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Provider Business Mailing Address
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Address Line | 1902 W WEBB AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-1062
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Country | US
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Telephone | 336-584-3736
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Fax | 336-584-3735
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Authorized Official
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Title or Position | PHARMACIST/MANAGER
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Name | MR. AUGUST RICHARD PETERS IV
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Credential | RPH
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Telephone | 336-584-3736
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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 | 07468
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License Number State | NC
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