Organization
ELBJ INC
Active
Other names
MEDICAP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY GRAHAM RPH (OWNER)
(336) 631-0093
Entity
Organization
Contact information
Practice address
1345 N LIBERTY ST, WINSTON SALEM, NC 27105-6625
(336) 631-0093
(336) 631-4882
Mailing address
1345 N LIBERTY ST, WINSTON SALEM, NC 27105-6625
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
09107
NC
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0347280
—
NC
01
—
3403829
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
7704355
—
NC
Enumeration date
11/15/2006
Last updated
03/07/2023
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