Provider Demographics
NPI:1356536791
Name:COMMUNITY PHARMACY OF TIMBERLAKE INC
Entity type:Organization
Organization Name:COMMUNITY PHARMACY OF TIMBERLAKE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-364-1053
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-0301
Mailing Address - Country:US
Mailing Address - Phone:336-364-1053
Mailing Address - Fax:336-364-1274
Practice Address - Street 1:413 HELENA MORIAH RD
Practice Address - Street 2:
Practice Address - City:TIMBERLAKE
Practice Address - State:NC
Practice Address - Zip Code:27583-7324
Practice Address - Country:US
Practice Address - Phone:336-364-1053
Practice Address - Fax:336-364-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3409465OtherNCPDP PROVIDER IDENTIFICATION NUMBER