Organization
THE DRUG STORE INC
Active
Other names
LEGACY CONSULTANT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL HOLLAND (EXECUTIVE MANAGER)
(888) 729-0729
Entity
Organization
Contact information
Practice address
3064 SALEM INDUSTRIAL DR, WINSTON SALEM, NC 27127-8854
(336) 831-0500
(855) 760-7126
Mailing address
3064 SALEM INDUSTRIAL DR, WINSTON SALEM, NC 27127-8854
(336) 831-0500
(855) 760-7126
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
12913
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0347064
—
NC
01
—
2069115
PK
—
05
—
8519412
—
VA
Enumeration date
06/21/2006
Last updated
05/09/2016
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