NPIMap

Organization Active NPI

Medical Park Pharmacy East, Inc.

Doing business as Medical Park Pharmacy East

  • Community/Retail Pharmacy
  • Beaufort, NC
National Provider Identifier
1396886701
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
09182 Issued in NC
Legal business name
MEDICAL PARK PHARMACY EAST, INC.
Doing business as
Medical Park Pharmacy East
Practice address
1513 Live Oak St
Beaufort, NC 28516-1518
Phone
(252) 504-2800
Fax
(252) 504-2805
NPI assigned
Feb 9, 2007
Last updated
Sep 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Authorized official

Name
Jeffrey Alan Williams, R.PH.NPI 1609243427
Title
President
Phone
(252) 504-2800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 09182 NC Primary

Addresses

Primary practice location

1513 Live Oak St
Beaufort, NC 28516-1518

Mailing address

1513 Live Oak St
Beaufort, NC 28516-1518
Phone (252) 504-2800

Other identifiers 2

IdentifierTypeStateIssuer
7704457MedicaidNC
0165449MedicaidNC

Other names 1

  • Medical Park Pharmacy East Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1396886701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 LIVE OAK ST",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "285161518",
            "telephone_number": "252-504-2800",
            "fax_number": "252-504-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 LIVE OAK ST",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "285161518",
            "telephone_number": "252-504-2800",
            "fax_number": "252-504-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARK PHARMACY EAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-504-2800",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "09182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704457",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0165449",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Park Pharmacy East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaufort, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.