MEDICARE: OAKWOOD 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	02429	NC
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	02429	NC
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0441E	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3401964	OTHER		NABP

General Provider Information

NPI Number	:	1942226097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKWOOD PHARMACY INC

Provider Business Mailing Address
First Line	:	329 N FAIRVIEW RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27801
Country	:	US
Telephone Number	:	252-442-8159
Fax Number	:	252-442-0332

Provider Business Practice Location Address
First Line	:	329 N FAIRVIEW RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27801
Country	:	US
Telephone Number	:	252-442-8159
Fax Number	:	252-442-0332

Authorized Official
Title or Position	:	MANAGER OWNER
Name	:	GARY STEPHEN JARED SR.
Credential	:	RPH
Telephone Number	:	252-442-8159

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/16/2008

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Directions to “OAKWOOD PHARMACY INC ” Practice Location

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