Provider Demographics
NPI:1538564596
Name:BLUE RIDGE PHARMACY INC
Entity type:Organization
Organization Name:BLUE RIDGE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-707-9700
Mailing Address - Street 1:106 LONG SHOALS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8432
Mailing Address - Country:US
Mailing Address - Phone:828-707-9700
Mailing Address - Fax:
Practice Address - Street 1:106 LONG SHOALS RD STE 100
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8432
Practice Address - Country:US
Practice Address - Phone:828-707-9700
Practice Address - Fax:877-654-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty