1225130784 NPI number — WHITLEY DRUGS, INC

Table of content: (NPI 1225130784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225130784 NPI number — WHITLEY DRUGS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITLEY DRUGS, 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:
Provider Other Organization Name Type Code:
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:
1225130784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 GREENVILLE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28792-5725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-692-4236
Provider Business Mailing Address Fax Number:
828-692-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 GREENVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792-5725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-692-4236
Provider Business Practice Location Address Fax Number:
828-692-6319
Provider Enumeration Date:
09/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-692-4236

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2631 , 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: 7703205 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0455485 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3407346 . This is a "NABP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".