Provider Demographics
NPI:1548288996
Name:PHARMACY PLUS OF NEW BERN, INC
Entity type:Organization
Organization Name:PHARMACY PLUS OF NEW BERN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:STROUD
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-636-3322
Mailing Address - Street 1:658 WHITE HORSE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7829
Mailing Address - Country:US
Mailing Address - Phone:252-752-2363
Mailing Address - Fax:252-752-0358
Practice Address - Street 1:1204 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2609
Practice Address - Country:US
Practice Address - Phone:252-636-3322
Practice Address - Fax:252-636-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3424049OtherNABP
NC7701205Medicaid
NC0255463Medicaid
NC0255463Medicaid