Healthcare Provider Details

I. General information

NPI: 1467899542
Provider Name (Legal Business Name): INGLES MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 BIG A RD
TOCCOA GA
30577-6028
US

IV. Provider business mailing address

PO BOX 603941
CHARLOTTE NC
28260-3941
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8711
  • Fax: 706-886-4956
Mailing address:
  • Phone: 828-669-2941
  • Fax: 828-669-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009925
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1163497
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP
# 2
Identifier7G9925
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 3
Identifier003135391A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MR. STEPHEN V CUCCHI
Title or Position: VP OF PHARMACY
Credential: RPH
Phone: 828-669-2941