Organization
GLEN RAVEN PHARMACY, INC.
Active
Other names
Glen Raven Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUGUST RICHARD PETERS IV RPH (PHARMACIST/MANAGER)
(336) 584-3736
Entity
Organization
Contact information
Practice address
1902 W WEBB AVE, BURLINGTON, NC 27217-1062
(336) 584-3736
Mailing address
1902 W WEBB AVE, BURLINGTON, NC 27217-1062
(336) 584-3736
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
07468
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015884
—
NC
05
—
7703170
—
NC
Enumeration date
11/08/2010
Last updated
11/08/2010
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