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NPI Code Detail

MEDICARE: EDC DRUG STORES INC

MEDICARE: EDC DRUG STORES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy8628NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13419909OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33419909OTHEROTHER ID NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629177845
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDC DRUG STORES INC
Provider Business Mailing Address
First Line : 200 NEWBERRY COMMONS
Second Line :
City : ETTERS
State : PA
Zip : 17319-9363
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5319 N ROXBORO ROAD
Second Line :
City : DURHAM
State : NC
Zip : 27712-2227
Country : US
Telephone Number : 919-471-1519
Fax Number :
Authorized Official
Title or Position : MANAGER ONLINE ADJUDICATION
Name : JENNIFER ZOREK
Credential :
Telephone Number : 717-975-5937
Provider Enumeration Date : 09/22/2006
Last Update Date : 09/11/2008

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Directions to “EDC DRUG STORES INC ” Practice Location

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