Organization
SELF MED RX MAIN STREET PHARMACY INC
Active
Parent organization
SELF-MED RX INC
Other names
MAIN STREET PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SELF-MED RX INC
Authorized official
MR. CHARLES M BENTLEY (CEO)
(800) 342-6450
Entity
Organization
Contact information
Practice address
460 MAIN ST, HIGHLANDS, NC 28741
(828) 526-8845
(828) 526-2367
Mailing address
PO BOX 6827, C/O SELF MED RX INC, ATLANTA, GA 30315
(800) 342-6450
(404) 614-0322
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
08061
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0565200
—
NC
01
—
3439646
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/12/2007
Last updated
10/30/2012
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