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Provider Information for 1033271002


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PHARMACY OF J IVERSON RIDDLE DEVELOPMENT CENTER

Other Names:  
Doing Business As: 
J IVERSON RIDDLE DEVELOPMENT CENTER

Organization Subpart: NO

NPI: 1033271002
Last Updated: 2024-03-07
Certification Date: 2024-03-07

Details

NameValue
NPI1033271002
Enumeration Date2006-12-15
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: JANICE SWEARINGEN RPH
Title: DIRECTOR OF PHCY SVCS
Phone: 8284332683
Mailing Address CBO DHHS CONTROLLERS OFC
2021 MAIL SERVICE CENTER
RALEIGH, NC 27699-0001
United States

Phone: 919-733-9867 | Fax:919-733-1512
 
Primary Practice Address 300 ENOLA RD
PHARMACY DEPARTMENT
MORGANTON, NC 28655-4608
United States

Phone: 828-433-2653 | Fax:828-433-2894
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2066483PK
MEDICAIDNC3406014
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 3336C0004X - Pharmacy - Compounding Pharmacy
No 3336I0012X - Pharmacy - Institutional Pharmacy
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyNC02677