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General NPI Number Information
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NPI Number | 1790923555
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Entity Type | Organization
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Legal Business Name | SENIOR CARE PHARMACY LLC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1207 CREWS RD STE D
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City | MATTHEWS
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State | NC
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Zip | 28105-7582
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Country | US
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Telephone | 704-246-6510
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Fax | 704-246-7775
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Provider Business Mailing Address
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Address Line | 1207 CREWS RD STE D
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City | MATTHEWS
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State | NC
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Zip | 28105-7582
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Country | US
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Telephone | 704-246-6510
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Fax | 704-246-7775
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Authorized Official
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Title or Position | MANGER
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Name | PAUL HOWARD
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Credential |
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Telephone | 704-246-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 10235
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License Number State | NC
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