Organization
BLOOD AND CANCER CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRISH D DEVASTHALI MD (PRESIDENT)
(910) 483-8586
Entity
Organization
Contact information
Practice address
2125 VALLEYGATE DR, SUITE 101, FAYETTEVILLE, NC 28304-3657
(910) 483-8586
(910) 483-9212
Mailing address
PO BOX 53095, FAYETTEVILLE, NC 28305-3095
(910) 483-8586
(910) 483-9212
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02699
BOARD OF PHARMACY
NC
01
—
02701
BOARD OF PHARMACY
NC
01
—
3400936
NCPDP NUMBER
NC
01
—
38929
LICENSE NUMBER
NC
Enumeration date
04/13/2007
Last updated
08/22/2020
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