NPIMap

Organization Active NPI

Old Main Pharmacy Inc

Doing business as Old Main Pharmacy

  • Pharmacy
  • Pembroke, NC
National Provider Identifier
1013152099
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
11213 Issued in NC
Legal business name
OLD MAIN PHARMACY INC
Doing business as
Old Main Pharmacy
Practice address
407 W 3Rd St
Pembroke, NC 28372-7977
Phone
(910) 522-5500
Fax
(910) 844-3017
NPI assigned
Dec 5, 2008
Last updated
Feb 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Justin Daniel
Title
President/Owner
Phone
(910) 521-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 11213 NC Primary

Addresses

Primary practice location

407 W 3Rd St
Pembroke, NC 28372-7977

Mailing address

PO Box 2639
Pembroke, NC 28372-2639
Phone (910) 521-5600

Other identifiers 1

IdentifierTypeStateIssuer
2143626OtherPK

Other names 1

  • Old Main Pharmacy Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1013152099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2639",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283722639",
            "telephone_number": "910-521-5600",
            "fax_number": "910-521-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W 3RD ST",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727977",
            "telephone_number": "910-522-5500",
            "fax_number": "910-844-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MAIN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "910-521-5600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "11213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143626",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Main Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.