Medical Park Pharmacy Greenville, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

10208 Issued in NC

Legal business name

MEDICAL PARK PHARMACY GREENVILLE, INC

Doing business as

Medical Park Pharmacy South

Practice address

4814 Old Tar Rd
Winterville, NC 28590-7852

Phone

(252) 752-8800

Fax

(252) 752-8808

NPI assigned

Dec 23, 2008

Organization subpart

No

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

Authorized official

Name

Robert Williams

Title

President

Phone

(252) 726-0777

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medical Park Pharmacy South Doing business as

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.

• Medical Park Pharmacy Greenville, Inc

  dba Medical Park Pharmacy

  • Pharmacy
  • Greenville, NC
  • NPI 1477891513
  NPD tax ID

Locations

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1720224702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4814 OLD TAR RD",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285907852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4814 OLD TAR RD",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285907852",
            "telephone_number": "252-752-8800",
            "fax_number": "252-752-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARK PHARMACY GREENVILLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-23",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-726-0777"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "10208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3413224",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Park Pharmacy South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tomha McMillan, MS, LMFT
• Michelle Green McNair
• Med 1 Inter-Facility Care LLC
• Erica Michelle Medford, PHARMD
• Evan Christopher Medford, PHARMD
• Raymond William Meyers
• Adam Henryk Michniak, AEMT
• Heather Mikesell
• Suparna Misra
• Niralee Atulkumar Modi, MS, RPH

• Community/Retail Pharmacy in Winterville, NC
• Providers in Winterville, 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 Mar 13, 2009; 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.