MEDICARE: PHARMAX, 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	3336C0004X	Compounding Pharmacy	07800	NC
2	3336C0003X	Community/Retail Pharmacy	07800	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3435129	OTHER	NC	NCPDP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043200363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMAX, INC.

Provider Business Mailing Address
First Line	:	102 N PATTERSON ST
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-1735
Country	:	US
Telephone Number	:	910-844-3100
Fax Number	:	910-844-3017

Provider Business Practice Location Address
First Line	:	102 N PATTERSON ST
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-1735
Country	:	US
Telephone Number	:	910-844-3100
Fax Number	:	910-844-3017

Authorized Official
Title or Position	:	RPH/OWNER
Name	:	DAVID S HESTER
Credential	:
Telephone Number	:	910-844-3100

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	03/07/2023

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Directions to “PHARMAX, INC. ” Practice Location

Language	Start Address	Practice Location

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