Organization
INDIAN TRAIL PHARMACY, INC.
Active
Other names
INDIAN TRAIL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN M STINE (OFFICE MANAGER/TREASURER)
(704) 821-7617
Entity
Organization
Contact information
Practice address
106 INDIAN TRAIL RD S, INDIAN TRAIL, NC 28079-9669
(704) 821-7617
(704) 821-0177
Mailing address
106 INDIAN TRAIL RD S, PO BOX 86, INDIAN TRAIL, NC 28079-9669
(704) 821-7617
(704) 821-0177
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
02670
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0905117
—
NC
01
—
3401128
NABP
—
Enumeration date
12/05/2012
Last updated
12/05/2012
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