Organization
CMC-NORTHEAST, INC.
Active
Other names
Pavilion Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN S FRASURE III PHARMD (MANAGER, OUTPATIENT PHARMACY SERVIC)
(704) 403-2079
Entity
Organization
Contact information
Practice address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-2079
Mailing address
920 CHURCH ST N, CONCORD, NC 28025-2927
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
09822
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376579052
NPI
—
Enumeration date
12/01/2008
Last updated
03/07/2023
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