Provider Demographics
NPI:1164634952
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-843-9255
Mailing Address - Street 1:6340 QUADRANGLE DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8077
Mailing Address - Country:US
Mailing Address - Phone:919-843-9255
Mailing Address - Fax:919-843-9210
Practice Address - Street 1:6340 QUADRANGLE DRIVE
Practice Address - Street 2:SUITE 170
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8077
Practice Address - Country:US
Practice Address - Phone:919-843-9255
Practice Address - Fax:919-843-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC100163336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0685536Medicaid
2067213OtherPK