1144366170 NPI number — MARTINS DRUG STORE INC

Table of content: (NPI 1144366170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144366170 NPI number — MARTINS DRUG STORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTINS DRUG STORE 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:
1144366170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28716-4428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-648-2321
Provider Business Mailing Address Fax Number:
828-648-2322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28716-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-648-2321
Provider Business Practice Location Address Fax Number:
828-648-2322
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURRUS
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
828-648-2321

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  02960 , 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: 3404364 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0445064 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com