Organization
OLD MAIN PHARMACY INC
Active
Other names
Old Main Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DANIEL (PRESIDENT/OWNER)
(910) 521-5600
Entity
Organization
Contact information
Practice address
407 W 3RD ST, PEMBROKE, NC 28372-7977
(910) 522-5500
(910) 844-3017
Mailing address
PO BOX 2639, PEMBROKE, NC 28372-2639
(910) 521-5600
(910) 521-1906
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
11213
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143626
PK
—
Enumeration date
12/05/2008
Last updated
02/20/2017
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