Provider Demographics
NPI:1144523424
Name:MCJT PHARMACEUTICAL CARE
Entity type:Organization
Organization Name:MCJT PHARMACEUTICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-572-2655
Mailing Address - Street 1:120 CEDAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2507
Mailing Address - Country:US
Mailing Address - Phone:828-572-2655
Mailing Address - Fax:
Practice Address - Street 1:510 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2401
Practice Address - Country:US
Practice Address - Phone:828-572-2655
Practice Address - Fax:828-572-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC106903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127982OtherPK
NC0145591Medicaid
3458254OtherNCPDP PROVIDER IDENTIFICATION NUMBER