NPIMap

Organization Active NPI

Medical Park Pharmacy Greenville, Inc

Doing business as Medical Park Pharmacy

  • Pharmacy
  • Greenville, NC
National Provider Identifier
1477891513
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
11060 Issued in NC
Legal business name
MEDICAL PARK PHARMACY GREENVILLE, INC
Doing business as
Medical Park Pharmacy
Practice address
1872 W Arlington Blvd
Suite M
Greenville, NC 27834-5704
Phone
(252) 321-0222
Fax
(252) 321-0508
NPI assigned
Jan 24, 2013
Last updated
Jan 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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

Authorized official

Name
Mr. Stephen Anthony Wicher, RPHNPI 1437466257
Title
VP
Phone
(252) 321-0222

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
Pharmacy 333600000X 11060 NC Primary

Addresses

Primary practice location

1872 W Arlington Blvd
Suite M
Greenville, NC 27834-5704

Mailing address

1872 W Arlington Blvd
Suite M
Greenville, NC 27834-5704
Phone (252) 321-0222

Other identifiers 2

IdentifierTypeStateIssuer
7704562MedicaidNC
0745961MedicaidNC

Other names 1

  • Medical Park Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Park Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1872 W Arlington Blvd
Ste M
Greenville, NC 27834
Phone (252) 321-0222

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": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1477891513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1872 W ARLINGTON BLVD",
            "address_2": "SUITE M",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345704",
            "telephone_number": "252-321-0222",
            "fax_number": "252-321-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1872 W ARLINGTON BLVD",
            "address_2": "SUITE M",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345704",
            "telephone_number": "252-321-0222",
            "fax_number": "252-321-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARK PHARMACY GREENVILLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "WICHER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "252-321-0222",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "11060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704562",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0745961",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.