Provider Demographics
NPI:1043200363
Name:PHARMAX, INC.
Entity type:Organization
Organization Name:PHARMAX, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-844-3100
Mailing Address - Street 1:102 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1735
Mailing Address - Country:US
Mailing Address - Phone:910-844-3100
Mailing Address - Fax:910-844-3017
Practice Address - Street 1:102 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1735
Practice Address - Country:US
Practice Address - Phone:910-844-3100
Practice Address - Fax:910-844-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078003336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703376Medicaid
NC3435129OtherNCPDP #
NC0785641Medicaid
NC0785641Medicaid
NC4164940001Medicare NSC