Organization
MEDI-K INC
Active
Other names
MEDSOURCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DALTON ANGE RPH (PRES)
(252) 522-0353
Entity
Organization
Contact information
Practice address
505 W VERNON AVE, STE 100, KINSTON, NC 28501-3700
(252) 522-0353
(252) 523-0058
Mailing address
505 W VERNON AVE, STE 100, KINSTON, NC 28501-3700
(252) 522-0353
(252) 523-0058
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
04233
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0545335
—
NC
01
—
2068888
PK
—
05
—
7701289
—
NC
Enumeration date
03/22/2006
Last updated
03/31/2016
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