Organization
TABOR CITY MEDICINE MART, INC
Active
Other names
TABOR CITY MEDICINE MART
Organization subpart
No
Provider details
NPI number
Authorized official
STERLING G KOONCE RPH (OWNER/PRESIDENT)
(910) 653-6805
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) 653-4800
(910) 653-4915
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245696
—
NC
Enumeration date
08/22/2006
Last updated
07/29/2020
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