MEDICARE: CAROLINA CARE 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	3336L0003X	Long Term Care Pharmacy	11267	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2135745	OTHER		PK

General Provider Information

NPI Number	:	1427311406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CARE PHARMACY INC

Provider Business Mailing Address
First Line	:	123 BRANCH ST STE G
Second Line	:
City	:	LOWELL
State	:	NC
Zip	:	28098-2044
Country	:	US
Telephone Number	:	704-648-8133
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 BRANCH ST STE G
Second Line	:
City	:	LOWELL
State	:	NC
Zip	:	28098-2044
Country	:	US
Telephone Number	:	704-879-4032
Fax Number	:	704-879-4063

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	KIMBERLY POPA
Credential	:
Telephone Number	:	704-648-8133

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	01/05/2016

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