Organization
COMMUNITY PHARMACY OF VALE LLC
Active
Other names
The Drug Store Vale
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH A LONG (MANAGER)
(704) 735-2556
Entity
Organization
Contact information
Practice address
9576 NC HWY 10W, VALE, NC 28168-7451
(704) 462-0226
(704) 462-0229
Mailing address
9576 NC 10 HWY W, VALE, NC 28168-9409
(704) 462-0226
(704) 462-0229
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
09378
NC
3336C0003X
Community/Retail Pharmacy
Primary
09378
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186299
—
NC
05
—
7704939
—
NC
Enumeration date
04/04/2008
Last updated
03/27/2017
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