Organization
TABOR CITY MEDICINE MART, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STERLING GRADY KOONCE (OWNER)
(910) 653-6804
Entity
Organization
Contact information
Practice address
220 S MAIN ST, TABOR CITY, NC 28463-1904
(910) 653-4800
(910) 653-4915
Mailing address
PO BOX 580, TABOR CITY, NC 28463-0580
(910) 653-6804
(910) 653-4915
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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