Organization
MEDI-K INC
Active
Other names
MedSource Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DALTON ANGE (RPH/PRESIDENT)
(252) 522-0353
Entity
Organization
Contact information
Practice address
2202 US HIGHWAY 258N, KINSTON, NC 28504-7223
(252) 522-2200
(252) 522-2202
Mailing address
2202 HWY 250 N, KINSTON, NC 28504
(252) 522-2200
(252) 522-2202
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
11293
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0545706
—
NC
01
—
2135610
PK
—
Enumeration date
06/18/2012
Last updated
02/24/2015
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