MEDICARE: ELM CITY 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	332B00000X	Durable Medical Equipment & Medical Supplies	04043	NC
2	3336C0003X	Community/Retail Pharmacy	04043	NC
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	04043	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	0387E	OTHER	NC	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831272566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELM CITY PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 637
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822-0637
Country	:	US
Telephone Number	:	252-236-4664
Fax Number	:	252-236-3078

Provider Business Practice Location Address
First Line	:	118 EAST MAIN STREET
Second Line	:
City	:	ELM CITY
State	:	NC
Zip	:	27822
Country	:	US
Telephone Number	:	252-236-4664
Fax Number	:	252-236-3078

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARVIN RUSSELL COWAN
Credential	:	RPH
Telephone Number	:	252-236-4664

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/11/2025

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Directions to “ELM CITY PHARMACY INC ” Practice Location

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