Organization
DAMERON DRUG STORE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY FOWLER LOVETT PHARMD (PHARMICIST)
(910) 653-3089
Entity
Organization
Contact information
Practice address
100 S MAIN ST, TABOR CITY, NC 28463-1910
(910) 653-3089
(910) 653-5839
Mailing address
100 S MAIN ST, TABOR CITY, NC 28463-1910
(910) 653-3089
(910) 653-5839
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
00917
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245100
—
NC
01
—
3411511
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
7N0917
—
SC
Enumeration date
12/01/2010
Last updated
12/01/2010
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