FAYETTEVILLE NC 3 VA CLINIC PH (4175)    INSTITUTION (4)

Name Value
NAME FAYETTEVILLE NC 3 VA CLINIC PH
STATE NORTH CAROLINA
STREET ADDR. 1 7300 S RAEFORD RD
CITY FAYETTEVILLE
ZIP 28304-6162
OFFICIAL VA NAME FAYETTEVILLE 3 VA CLINIC PHARM
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME FAYETTEVILLE NC 3 VA CLINIC PHARMACY
EFFECTIVE DATE/TIME
  • 2015-09-15 00:00:00
    STATUS:   ACTIVE
    NPI:   1699146019
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA