Healthcare Provider Details

I. General information

NPI: 1427099324
Provider Name (Legal Business Name): CHINA GROVE DRUG CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S MAIN ST
CHINA GROVE NC
28023-2448
US

IV. Provider business mailing address

112 S MAIN ST
CHINA GROVE NC
28023-2448
US

V. Phone/Fax

Practice location:
  • Phone: 704-857-7951
  • Fax: 705-857-1000
Mailing address:
  • Phone: 704-857-7951
  • Fax: 705-857-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5189
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN A KISER
Title or Position: PRESIDENT
Credential:
Phone: 704-857-7951