=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982709309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDEXPRESS PHARMACY, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 12/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 W. INNES STREET
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-633-3977
-----------------------------------------------------
Fax | 800-615-0075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 W. INNES STREET
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-633-3977
-----------------------------------------------------
Fax | 800-615-0075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF PHARM. OPS
-----------------------------------------------------
Name | DAWN DEPORTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-236-1549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 07849
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 12033
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------