Organization Name: | OLD MAIN PHARMACY INC |
NPI Number: | 1013152099 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUSTIN L DANIEL (OWNER/PRESIDENT) |
Mailing Address: | 407 W 3rd St Pembroke |
State: | NC US |
Postal Code: | 283727977 |
Phone Number: | 9105225500 |
Fax Number: | 9108443017 |
NPI Enumeration Date: | 12/05/2008 |
NPI Last Update Date: | 12/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |