Provider Demographics
NPI:1366409443
Name:MEDIPHARM, INC.
Entity type:Organization
Organization Name:MEDIPHARM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-322-4499
Mailing Address - Street 1:3412 GRAYSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8200
Mailing Address - Country:US
Mailing Address - Phone:828-322-4499
Mailing Address - Fax:828-322-7655
Practice Address - Street 1:3412 GRAYSTONE PL
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8200
Practice Address - Country:US
Practice Address - Phone:828-322-4499
Practice Address - Fax:828-322-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
NC5431332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0185835Medicaid
NC0185835Medicaid