Organization
BSE, INC
Active
Other names
The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY HESTER M.D. (PRESIDENT)
(910) 863-3949
Entity
Organization
Contact information
Practice address
102 SOUTH MAIN ST, BLADENBORO, NC 28320-0508
(910) 863-3949
(910) 863-3940
Mailing address
PO BOX 508, BLADENBORO, NC 28320-0508
(910) 863-3949
(910) 863-3940
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
04410
NC
332B00000X
Durable Medical Equipment & Medical Supplies
04410
NC
3336C0003X
Community/Retail Pharmacy
Primary
04410
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095166
—
NC
01
—
0388B
BC BS PROVIDER NUMBER
NC
01
—
3416282
NCPDP #
NC
05
—
7703225
—
NC
Enumeration date
12/13/2005
Last updated
03/07/2023
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