Basic Information
| Provider Information | |||||||||
| NPI: | 1679629760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL APOTHECARY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 448 | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286300448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283962387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 SUNSET ST | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286301770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283962387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8283962387 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | NH0380 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 0145391 | 05 | NC | MEDICAID |