1730671322 NPI number — DDP PHARMACY, 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 1730671322 NPI number — DDP PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DDP PHARMACY, 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:
6
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:
1730671322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 SMITH CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE RAPIDS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27870-4911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-519-1144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1096 E 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-410-1450
Provider Business Practice Location Address Fax Number:
252-410-1460
Provider Enumeration Date:
05/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HUGGINS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
252-519-1144

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: 13752 , 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: 2176792 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com