Organization
WALNUT COVE PHARMACY INC
Active
Other names
FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD WATTS RPH (OWNER)
(336) 591-7171
Entity
Organization
Contact information
Practice address
317 N MAIN ST, WALNUT COVE, NC 27052-9200
(336) 591-7171
(336) 591-7936
Mailing address
PO BOX 537, WALNUT COVE, NC 27052-0537
(336) 591-7171
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5086
NC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0855148
—
NC
01
—
3416321
OTHER ID NUMBER
—
01
—
Q492110001
MEDICARE PTAN
NC
Enumeration date
09/26/2006
Last updated
10/26/2016
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