Organization
CLINTON DRUG COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JAE BASS R.PH. (PHARMACY MANAGER)
(910) 592-8444
Entity
Organization
Contact information
Practice address
307 BEAMAN ST, CLINTON, NC 28328-2907
(910) 592-8444
(910) 592-6505
Mailing address
307 BEAMAN ST, CLINTON, NC 28328-2907
(910) 592-8444
(910) 592-6505
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
05533
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05533
NC BOARD OF PHARMACY REGISTRATION
NC
05
—
0825281
—
NC
01
—
Q36805A
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
NC
Enumeration date
12/19/2011
Last updated
12/19/2011
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