Provider Demographics
NPI:1750923678
Name:HEALTH PARK PHARMACY LLC
Entity type:Organization
Organization Name:HEALTH PARK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:919-847-7645
Mailing Address - Street 1:8300 HEALTH PARK STE 227
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4731
Mailing Address - Country:US
Mailing Address - Phone:919-847-7645
Mailing Address - Fax:919-847-7641
Practice Address - Street 1:8300 HEALTH PARK STE 227
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-847-7645
Practice Address - Fax:919-847-7641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PARK PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920708Medicaid