=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477611663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL CENTER PHARMACY OF WILMINGTON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 912 S 16TH ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-763-1896
-----------------------------------------------------
Fax | 910-763-1709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 912 S 16TH ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-763-1896
-----------------------------------------------------
Fax | 910-763-1709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/MANAGER/SECRETARY
-----------------------------------------------------
Name | AUSTIN MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-808-9838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5247
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------