Organization
CHINA GROVE DRUG CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN A KISER (PRESIDENT)
(704) 857-7951
Entity
Organization
Contact information
Practice address
112 S MAIN ST, CHINA GROVE, NC 28023-2448
(704) 857-7951
(705) 857-1000
Mailing address
112 S MAIN ST, CHINA GROVE, NC 28023-2448
(704) 857-7951
(705) 857-1000
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5189
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0161130001
MEDICARE DME
—
05
—
0805028
—
NC
Enumeration date
06/09/2006
Last updated
06/03/2022
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