Healthcare Provider Details

I. General information

NPI: 1174847636
Provider Name (Legal Business Name): ANGIER DISCOUNT DRUG OF NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 N RALIEGH STREET
ANGIER NC
27501
US

IV. Provider business mailing address

PO BOX 1837
ANGIER NC
27501-1837
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-9623
  • Fax: 919-639-9670
Mailing address:
  • Phone: 919-639-9623
  • Fax: 919-639-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10560
License Number StateNC

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 910-591-8709