1104968072 NPI number — TH&S LLC

Table of content: (NPI 1104968072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104968072 NPI number — TH&S LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TH&S LLC
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:
THOMAS DRUGS
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:
1104968072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHALLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28459-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-754-4942
Provider Business Mailing Address Fax Number:
252-754-9747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4750 MAIN STREET
Provider Second Line Business Practice Location Address:
HIGHWAY 17
Provider Business Practice Location Address City Name:
SHALOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-754-4942
Provider Business Practice Location Address Fax Number:
910-754-9747
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
DAIL
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
910-754-4942

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  03068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BP3500X , with the licence number: 03068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X , with the licence number: 03068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X , with the licence number: 03068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: 03068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: DE1588 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7701246 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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