Organization
MEDICINE MART LTC, LLC
Active
Organization
MEDICINE MART LTC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STERLING G KOONCE RPH (MANAGING AGENT)
(910) 653-6805
Entity
Organization
Contact information
Practice address
214 S MAIN ST, TABOR CITY, NC 28463-1904
(910) 653-6804
(910) 653-4915
Mailing address
PO BOX 550, TABOR CITY, NC 28463-0550
(910) 653-6804
(910) 653-4915
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
084535
NC
3336S0011X
Specialty Pharmacy
08435
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245845
—
NC
Enumeration date
08/22/2006
Last updated
07/30/2020
Update your record
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