MEDICARE: MEDICAL CENTER PHARMACY OF CHERRYVILLE 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	02151	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02151	OTHER	NC	BOARD OF PHARMACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942231535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER PHARMACY OF CHERRYVILLE INC

Provider Business Mailing Address
First Line	:	607 E ACADEMY ST
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021
Country	:	US
Telephone Number	:	704-435-3263
Fax Number	:	704-435-9499

Provider Business Practice Location Address
First Line	:	607 E ACADEMY ST
Second Line	:
City	:	CHERRYVILLE
State	:	NC
Zip	:	28021
Country	:	US
Telephone Number	:	704-435-3263
Fax Number	:	704-435-9499

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. BRIAN DAVID KISER
Credential	:	OFFICE MANAGER
Telephone Number	:	704-435-3263

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/07/2023

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