Organization Active NPI

Pungo River Pharmacy Inc

  • Durable Medical Equipment & Medical Supplies
  • Belhaven, NC
National Provider Identifier
1396882973
Registry record updated Sep 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PUNGO RIVER PHARMACY INC
Practice address
892 US Highway 264 Byp
Belhaven, NC 27810-9771
Phone
(252) 943-2585
Fax
(252) 943-3076
NPI assigned
Jan 31, 2007
Last updated
Sep 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2011

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

Authorized official

Name
Scott EllisNPI 1811149701
Title
Owner
Phone
(252) 943-2585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

892 US Highway 264 Byp
Belhaven, NC 27810-9771

Mailing address

892 US Highway 264 Byp
Belhaven, NC 27810-9771
Phone (252) 943-2585

Other identifiers 1

IdentifierTypeStateIssuer
7700043MedicaidNC

National Provider Directory

National Provider Directory

Locations

892 US Highway 264 Byp
Belhaven, NC 27810
Phone (252) 943-2307

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316390400000",
    "number": "1396882973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 US HIGHWAY 264 BYP",
            "city": "BELHAVEN",
            "state": "NC",
            "postal_code": "278109771",
            "telephone_number": "252-943-2585",
            "fax_number": "252-943-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "892 US HIGHWAY 264 BYP",
            "city": "BELHAVEN",
            "state": "NC",
            "postal_code": "278109771",
            "telephone_number": "252-943-2585",
            "fax_number": "252-943-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUNGO RIVER PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2011-09-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-943-2585"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7700043",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belhaven, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; 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.