Provider Demographics
NPI:1679638167
Name:HEALTH PARK PHARMACY LLC
Entity type:Organization
Organization Name:HEALTH PARK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:919-847-7645
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 227
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4731
Mailing Address - Country:US
Mailing Address - Phone:919-847-7645
Mailing Address - Fax:919-857-7641
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 227
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-847-7645
Practice Address - Fax:919-847-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11200333600000X
NC93073336C0003X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920708Medicaid
NC7704623Medicaid
NC11200OtherPHARMACY PERMIT
3407459OtherNCPDP
BH9977349OtherDEA
BH9977349OtherDEA