1962584755 NPI number — ROCK DRUG OF VALDESE LLC

Table of content: (NPI 1962584755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962584755 NPI number — ROCK DRUG OF VALDESE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK DRUG OF VALDESE 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:
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:
1962584755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 248
Provider Second Line Business Mailing Address:
240 MAIN ST WEST
Provider Business Mailing Address City Name:
VALDESE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28690-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-879-9812
Provider Business Mailing Address Fax Number:
828-874-8915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MAIN ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDESE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28690-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-879-9812
Provider Business Practice Location Address Fax Number:
828-874-8915
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANNON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
MANAGER LLC
Authorized Official Telephone Number:
828-879-9812

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  11094 , 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: 3411725 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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