=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326503657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE PHARMACY OF HAMPSTEAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14057 HWY 17 SUITE 100
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-319-6050
-----------------------------------------------------
Fax | 910-319-6045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 E CREEKVIEW DR
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-520-2248
-----------------------------------------------------
Fax | 910-821-0330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | ELIZABETH MCBRAYER CAVENESS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 910-520-2248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------