1508886029 NPI number — REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508886029 NPI number — REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REALO DISCOUNT DRUGS OF EASTERN NC INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508886029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28562-2213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-639-9006
Provider Business Mailing Address Fax Number:
252-639-9005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 BRIDGE TOWN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28560-7192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-636-0236
Provider Business Practice Location Address Fax Number:
252-672-1786
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-639-9006

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 08326 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0255686 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2069686 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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