Provider Demographics
NPI:1861936809
Name:CARY LONG TERM CARE PHARMACY LLC
Entity type:Organization
Organization Name:CARY LONG TERM CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PECK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-977-9011
Mailing Address - Street 1:135 PARKWAY OFFICE CT
Mailing Address - Street 2:STE 105
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7424
Mailing Address - Country:US
Mailing Address - Phone:919-977-9011
Mailing Address - Fax:
Practice Address - Street 1:135 PARKWAY OFFICE CT
Practice Address - Street 2:STE 105
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7424
Practice Address - Country:US
Practice Address - Phone:919-977-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3336M0002X, 3336S0011X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy