MEDICARE: MEDICINE BOX PHARMACY OF RUTHERFORDTON, 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
1	183500000X	Pharmacist	07481	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962781120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE BOX PHARMACY OF RUTHERFORDTON, INC

Provider Business Mailing Address
First Line	:	200 CHARLOTTE RD
Second Line	:
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-2914
Country	:	US
Telephone Number	:	828-287-7117
Fax Number	:	828-287-7649

Provider Business Practice Location Address
First Line	:	200 CHARLOTTE RD
Second Line	:
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-2914
Country	:	US
Telephone Number	:	828-287-7117
Fax Number	:	828-287-7649

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	MRS. LAURA SMITH HODGE
Credential	:	RPH
Telephone Number	:	828-287-7117

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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