=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639535156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIVE POINTS PHARMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2016
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 FAIRGROVE CHURCH RD SE
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-8609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-322-4505
-----------------------------------------------------
Fax | 828-322-2669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 FAIRGROVE CHURCH RD SE
-----------------------------------------------------
City | CONOVER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28613-8609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-322-4505
-----------------------------------------------------
Fax | 828-322-2669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | KELLY CROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-322-4505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 12909
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------