=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740377613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIANGLE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 E HIGHWAY 54
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-544-1711
-----------------------------------------------------
Fax | 919-544-0381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 E HIGHWAY 54
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-544-1711
-----------------------------------------------------
Fax | 919-544-0381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH
-----------------------------------------------------
Name | ALICE DILLARD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 919-544-1711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 03201
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------