Organization
A&B WYATT ENTERPRISES, INC.
Active
Other names
The Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN J. WYATT (OWNER/PHARMACIST MANAGER)
(336) 573-2200
Entity
Organization
Contact information
Practice address
104 N HENRY ST, STONEVILLE, NC 27048
(336) 573-2200
(336) 573-2201
Mailing address
PO BOX 258, STONEVILLE, NC 27048-0258
(336) 573-2200
(336) 573-2201
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
08149
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0795775
—
NC
01
—
3440601
NCPDP NUMBER
NC
01
—
7704002
MEDICAID DME SUPPLIER NUM
NC
Enumeration date
08/29/2006
Last updated
08/21/2014
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