Provider Demographics
NPI:1023163292
Name:CAROLINA COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:CAROLINA COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-835-9500
Mailing Address - Street 1:323 TRIPLETT STREET
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642
Mailing Address - Country:US
Mailing Address - Phone:336-835-9500
Mailing Address - Fax:336-526-8329
Practice Address - Street 1:323 TRIPLETT STREET
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642
Practice Address - Country:US
Practice Address - Phone:336-835-9500
Practice Address - Fax:336-526-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC088953336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403716OtherNCPDP NUMBER
NC3403716OtherNCPDP NUMBER