Healthcare Provider Details

I. General information

NPI: 1063521086
Provider Name (Legal Business Name): REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ENTERPRISE AVE
CAPE CARTERET NC
28584-2506
US

IV. Provider business mailing address

1301 COMMERCE DR
NEW BERN NC
28562-2213
US

V. Phone/Fax

Practice location:
  • Phone: 252-393-3345
  • Fax: 252-393-3346
Mailing address:
  • Phone: 252-639-9006
  • Fax: 252-639-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number4913000003
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number4913000003
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09384
License Number StateNC

VIII. Authorized Official

Name: MR. ROBERT JOSEPH MCLAUGHLIN JR.
Title or Position: PRESIDENT
Credential: RPH
Phone: 252-639-9006