Organization
COOR'S PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE P ELLISON JR. RPH (PRESIDENT)
(919) 735-0400
Entity
Organization
Contact information
Practice address
1103 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-2957
(919) 735-0400
(919) 735-3530
Mailing address
1103 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-2957
(919) 735-0400
(919) 735-3530
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
09270
NC
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
09270
NC
3336C0003X
Community/Retail Pharmacy
Primary
09270
NC
335E00000X
Prosthetic/Orthotic Supplier
09270
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03900
BCBS PROVIDER NUMBER
NC
05
—
0965733
—
NC
01
—
3429289
NABP
NC
05
—
7704425
—
NC
Enumeration date
07/10/2006
Last updated
10/23/2008
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