Provider Demographics
NPI:1366443988
Name:OMNICARE OF CAROLINA
Entity type:Organization
Organization Name:OMNICARE OF CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-762-1419
Mailing Address - Street 1:4901 CASWELL PL W
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8136
Mailing Address - Country:US
Mailing Address - Phone:800-762-1419
Mailing Address - Fax:800-542-3323
Practice Address - Street 1:4901 CASWELL PL W
Practice Address - Street 2:SUITE D
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8136
Practice Address - Country:US
Practice Address - Phone:800-762-1419
Practice Address - Fax:800-542-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06223333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3428984OtherNABP
NC0645291Medicaid
NC0645291Medicaid
NC0645291Medicaid