Provider Demographics
NPI:1922844273
Name:PINEVILLE PHARMACY LTC
Entity type:Organization
Organization Name:PINEVILLE PHARMACY LTC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KISHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-275-8791
Mailing Address - Street 1:311 S POLK ST STE 80
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8632
Mailing Address - Country:US
Mailing Address - Phone:704-275-8791
Mailing Address - Fax:704-666-8356
Practice Address - Street 1:311 S POLK ST STE 80
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8632
Practice Address - Country:US
Practice Address - Phone:704-275-8791
Practice Address - Fax:704-666-8356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-06
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy