Provider Demographics
NPI:1144313578
Name:FUTRELL PHARMACY SERVICE INC
Entity type:Organization
Organization Name:FUTRELL PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-534-6001
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845-0768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:252-534-1906
Practice Address - Street 1:119 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-9599
Practice Address - Country:US
Practice Address - Phone:252-534-6001
Practice Address - Fax:252-534-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC032883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC665083Medicaid
NC0463790001Medicaid
NC7700136Medicaid
2068035OtherPK