=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912147455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPICE PHARMACY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2009
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3072 TRENWEST DR STE A
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-3219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-723-1679
-----------------------------------------------------
Fax | 336-723-1670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3072 TRENWEST DR SUITE A
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-723-1679
-----------------------------------------------------
Fax | 336-723-1670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JERRY BEAMER
-----------------------------------------------------
Credential | BSPHARM
-----------------------------------------------------
Telephone | 336-723-1679
-----------------------------------------------------
=====================================================
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 | 0214001549
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | 10226
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------