Organization
WALDEN ASSOCIATES INC
Active
Other names
SUPER REX DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BALLARD RPH (PIC)
(336) 367-5333
Entity
Organization
Contact information
Practice address
106 E MAIN ST, BOONVILLE, NC 27011-8764
(336) 367-5333
Mailing address
PO BOX 10, BOONVILLE, NC 27011-0010
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
04148
NC
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0995118
—
NC
01
—
2069029
PK
—
Enumeration date
10/23/2006
Last updated
05/20/2015
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