NPIMap

Organization Active NPI

Clinton Pharmacy LLC

  • Community/Retail Pharmacy
  • Clinton, NC
National Provider Identifier
1891762134
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11778 Issued in NC
Legal business name
CLINTON PHARMACY LLC
Practice address
307 Beaman St
Clinton, NC 28328-2907
Phone
(910) 592-8444
Fax
(910) 592-6505
NPI assigned
Mar 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Authorized official

Name
Amanda BryanNPI 1073925822
Title
Managing Partner
Phone
(910) 385-1602

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 11778 NC Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

307 Beaman St
Clinton, NC 28328-2907

Mailing address

307 Beaman St
Clinton, NC 28328-2907
Phone (910) 592-8444

Other identifiers 1

IdentifierTypeStateIssuer
2144114OtherPK

Other names 1

  • Clinton Drug Company Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140225000052 NC Part B Supplier - Pharmacy 3274763941 Practice locations: Clinton, NC
O20200526001559 NC Part B Supplier - Independent Clinical Laboratory 3274763941 Practice locations: Clinton, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1891762134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282907",
            "telephone_number": "910-592-8444",
            "fax_number": "910-592-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BEAMAN ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282907",
            "telephone_number": "910-592-8444",
            "fax_number": "910-592-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "910-385-1602"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11778",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144114",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinton Drug Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.