NPIMap

Organization Active NPI

Crescent Foods, Inc.

Doing business as Mt. Olive Pharmacy

  • Pharmacy
  • Mount Olive, NC
National Provider Identifier
1669556478
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
08289 Issued in NC
Legal business name
CRESCENT FOODS, INC.
Doing business as
Mt. Olive Pharmacy
Practice address
615 N Breazeale Ave
Mount Olive, NC 28365-1203
Phone
(919) 658-8660
Fax
(919) 658-8630
NPI assigned
Oct 25, 2006
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CRESCENT FOODS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
David Brendan DearieNPI 1558661165
Title
Pharmacy Manager
Phone
(919) 658-8660

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 NC
Pharmacy 333600000X 08289 NC Primary

Addresses

Primary practice location

615 N Breazeale Ave
Mount Olive, NC 28365-1203

Mailing address

615 N Breazeale Ave
Mount Olive, NC 28365-1203
Phone (919) 658-8660

Other names 1

  • Mt. Olive Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190911002094 NC Part B Supplier - Mass Immunization (Roster Biller Only) 2668539834 Practice locations: Mount Olive, NC

National Provider Directory

National Provider Directory
Part of
Mount Olive Pharmacy

Locations

206 SW Center St
Faison, NC 28341
Phone (910) 267-0080

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1669556478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N BREAZEALE AVE",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283651203",
            "telephone_number": "919-658-8660",
            "fax_number": "919-658-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N BREAZEALE AVE",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283651203",
            "telephone_number": "919-658-8660",
            "fax_number": "919-658-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT FOODS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRESCENT FOODS, INC.",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "DEARIE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRENDAN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "919-658-8660"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "08289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Olive Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt. Olive Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Olive, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.