=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558985580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALIFAX REGIONAL MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2020
-----------------------------------------------------
Last Update Date | 09/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 SMITH CHURCH ROAD
-----------------------------------------------------
City | ROANOKE RAPIDS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-535-8274
-----------------------------------------------------
Fax | 252-535-8273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1089
-----------------------------------------------------
City | ROANOKE RAPIDS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-535-8274
-----------------------------------------------------
Fax | 252-535-8273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | AMY BENNETT
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 252-353-8274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------