Medexpress Pharmacy, LTD.

Primary specialty

PharmacyTaxonomy code 333600000X

License

12033 Issued in NC

Legal business name

MEDEXPRESS PHARMACY, LTD.

Practice address

1431 W. Innes Street
Salisbury, NC 28145

Phone

(800) 633-3977

Fax

(800) 615-0075

NPI assigned

Sep 13, 2006

Last updated

Dec 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dawn Deporter

Title

VP of Pharm. Ops

Phone

(225) 236-1549

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medexpress Pharmacy, LTD.

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1891381406

  O20241001002679

  Same enrollment

Tax ID family

Medexpress Pharmacy LTD2 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.

• Medexpress Pharmacy, LTD.

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1891381406
  NPD tax ID

Locations

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.

• Jacqueline Susanne Hurlbut, RPH.

  • Pharmacist
  • Clemmons, NC
  • NPI 1154616308
  NPD (past)
• Kara L Maryansky

  • Pharmacist
  • Salisbury, NC
  • NPI 1124504220
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1982709309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 W. INNES STREET",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "28145",
            "telephone_number": "800-633-3977",
            "fax_number": "800-615-0075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 W. INNES STREET",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "28145",
            "telephone_number": "800-633-3977",
            "fax_number": "800-615-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEXPRESS PHARMACY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "DEPORTER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "VP OF PHARM. OPS",
        "authorized_official_telephone_number": "225-236-1549"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "07849",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "12033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3439278",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805739",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010071267",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982709309",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.