=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699107961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RALEIGH ORTHOPAEDIC PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2013
-----------------------------------------------------
Last Update Date | 01/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 EDWARDS MILL RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27612-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-645-1411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 EDWARDS MILL RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27612-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-645-1411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRIAN SCOTT BIZUB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-863-6801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 11592
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------