MEDICARE: CCCH 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	11197	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3459787	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1225309925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCCH INC

Provider Business Mailing Address
First Line	:	CCCH INC
Second Line	:	P.O. BOX 610
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040
Country	:	US
Telephone Number	:	336-922-0558
Fax Number	:	336-922-0566

Provider Business Practice Location Address
First Line	:	4611 YADKINVILLE RD
Second Line	:
City	:	PFAFFTOWN
State	:	NC
Zip	:	27040-8622
Country	:	US
Telephone Number	:	336-922-0558
Fax Number	:	336-922-0566

Authorized Official
Title or Position	:	PIC
Name	:	CHARLES AUSTIN
Credential	:
Telephone Number	:	336-922-0558

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	11/27/2012

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Directions to “CCCH INC ” Practice Location

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