MEDICARE: 786 PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	13198	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2170335	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033215421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	786 PHARMACY INC

Provider Business Mailing Address
First Line	:	316 S MAIN ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3320
Country	:	US
Telephone Number	:	336-227-2093
Fax Number	:	336-227-7401

Provider Business Practice Location Address
First Line	:	316 S MAIN ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3320
Country	:	US
Telephone Number	:	336-227-2093
Fax Number	:	336-227-7401

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MOAZZAM SHAIKH
Credential	:
Telephone Number	:	336-227-2093

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/19/2018

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