Old Monroe Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

OLD MONROE PHARMACY LLC

Practice address

4514 Old Monroe Rd Ste a
Indian Trail, NC 28079-5308

Phone

(704) 831-7895

NPI assigned

Jul 24, 2022

Organization subpart

No

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

Authorized official

Name

Glenn ShieldsNPI 1881036507

Title

Pharmacy Manager

Phone

(704) 301-4651

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glenn Paul Shields, PHARMD

  • Pharmacist
  • Indian Trail, NC
  • NPI 1881036507
  NPD Authorized official

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

{
    "created_epoch": "1658620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1396470209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4514 OLD MONROE RD STE A",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4514 OLD MONROE RD STE A",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280795308",
            "telephone_number": "704-831-7895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MONROE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-24",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "704-301-4651"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Elaine O'Shields, LMFT
• Oasis Clinical Care Management & Consultation PLLC
• Valarie Odle, COTA
• Gary Charles Of, PT
• Gina J Ohmann, PHYSICAL THERAPIST
• Bailey Graddon Oleary, CCC-SLP
• Tessa Ridley Oles, MS, OTR/L
• Nicole Curcio Oliver, PA
• Onward Consulting Services
• Megan Joy Orange, PA-C

• Community/Retail Pharmacy in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.