Senior Care Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

10235 Issued in NC

Legal business name

SENIOR CARE PHARMACY LLC

Doing business as

Copper Creek Pharmacy

Practice address

1207 Crews Rd Ste D
Matthews, NC 28105-7582

Phone

(704) 246-6510

Fax

(704) 246-7775

NPI assigned

Jan 30, 2009

Organization subpart

No

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

Authorized official

Name

Paul Howard

Title

Manger

Phone

(704) 246-6510

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Copper Creek Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1790923555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 CREWS RD STE D",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057582",
            "telephone_number": "704-246-6510",
            "fax_number": "704-246-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 CREWS RD STE D",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057582",
            "telephone_number": "704-246-6510",
            "fax_number": "704-246-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CARE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MANGER",
        "authorized_official_telephone_number": "704-246-6510"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NC",
            "license": "10235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2119183",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0602342",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Creek Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Matthews, NC
• Providers in Matthews, NC by specialty
• Long Term Care Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.