Organization
INNES STREET DRUG CO. INC. #3
Active
Parent organization
INNES STREET DRUG CO.,INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNES STREET DRUG CO.,INC
Authorized official
MR. STEPHEN WELDON FULLER (VICE-PRESIDENT/ PHARMACIST-MANAGER)
(704) 636-1712
Entity
Organization
Contact information
Practice address
1706 W INNES ST, SALISBURY, NC 28144-2552
(704) 636-1712
(704) 637-0324
Mailing address
1706 W INNES ST, SALISBURY, NC 28144-2552
(704) 636-1712
(704) 637-0324
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
05609
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0805473
—
NC
01
—
Q371140001
MEDICARE PTAN
NC
Enumeration date
12/20/2011
Last updated
12/20/2011
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