Healthcare Provider Details

I. General information

NPI: 1285754564
Provider Name (Legal Business Name): ONEALS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 E MAIN ST
BELHAVEN NC
27810-1414
US

IV. Provider business mailing address

292 E MAIN ST
BELHAVEN NC
27810-1414
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-2643
  • Fax:
Mailing address:
  • Phone: 252-943-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number000054
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number000054
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number000054
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number000054
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000054
License Number StateNC

VIII. Authorized Official

Name: WALTON ONEAL III
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 252-943-2643