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General NPI Number Information
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NPI Number | 1376798678
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Entity Type | Organization
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Legal Business Name | CMC-NORTHEAST, INC.
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 920 CHURCH ST N
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City | CONCORD
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State | NC
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Zip | 28025-2927
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Country | US
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Telephone | 704-403-2079
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Fax |
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Provider Business Mailing Address
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Address Line | 920 CHURCH ST N
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City | CONCORD
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State | NC
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Zip | 28025-2927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, OUTPATIENT PHARMACY SERVIC
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Name | EVAN S FRASURE III
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Credential | PHARMD
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Telephone | 704-403-2079
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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 | 09822
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License Number State | NC
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