Black River Health Services Inc
Organization Active NPI Community/Retail Pharmacy · Atkinson, NC
NPI 1215488317 · NPPES record last updated Feb 5, 2024
Key facts
- NPI
- 1215488317
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 13102 (NC)
- Legal business name
- BLACK RIVER HEALTH SERVICES INC
- Practice address
- 124 W Main St
Atkinson, NC 28421-0069 - Phone
- (910) 283-5400
- Fax
- (910) 283-7336
- NPI assigned
- Oct 24, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Janice Chapman McDermott, PHARMD
- Title
- Pharmacist
- Phone
- (910) 283-5400
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 3
Practitioners 17
-
William Fossett, FNP-C
-
Kristina Gardner, APRN-FNP-C
-
Jennifer L. Givens, DNP
-
Linda I Greenspan, D.O.
-
Jodie Butler Hall, FNP-C
-
Holly Ann Kilian, NP
-
Roisin Clare Reidy, FNP-C
-
Jerrol J Robinson, FNP-BC
-
Laterriar Turner, LCSW
-
Jennifer Anne Witkowski, LCHMC, MA/QP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151001001556 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 0345131579 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Atkinson, NC; Maple Hill, NC |
National Provider Directory
- Tax ID family
- Black River Health Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 13102 | NC | Yes |
Addresses
Primary practice location
124 W Main St
Atkinson, NC 28421-0069
Mailing address
124 W Main St
Atkinson, NC 28421-0069
Phone (910) 283-5400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0715269 | Medicaid | NC | |
| 2164625 | Other | PK |
Other names
- Atkinson Drug
Other providers in Atkinson, NC
- Black River Health Services Inc
- Emily Givens Byrd
- Tracy Marie Custis Raynor
- Eldo, Inc
- William Fossett
- Gift of Love, Inc
All providers in Atkinson, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.