MEDICARE: NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC

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	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1720633084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	2250 SHIPYARD BLVD STE 12
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-667-5147
Fax Number	:	910-815-5189

Provider Business Practice Location Address
First Line	:	2250 SHIPYARD BLVD STE 12
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-662-7755
Fax Number	:	910-662-7777

Authorized Official
Title or Position	:	DIRECTOR OF RETAIL & SPECIALTY RX
Name	:	DR. MICHAEL EDGERTON
Credential	:	PHARMD
Telephone Number	:	910-667-5147

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	02/10/2021

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