Healthcare Provider Details

I. General information

NPI: 1447529631
Provider Name (Legal Business Name): CLINTON DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BEAMAN ST
CLINTON NC
28328-2907
US

IV. Provider business mailing address

307 BEAMAN ST
CLINTON NC
28328-2907
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8444
  • Fax: 910-592-6505
Mailing address:
  • Phone: 910-592-8444
  • Fax: 910-592-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05533
License Number StateNC

VIII. Authorized Official

Name: MR. STEVEN JAE BASS
Title or Position: PHARMACY MANAGER
Credential: R.PH.
Phone: 910-592-8444