Healthcare Provider Details

I. General information

NPI: 1396842357
Provider Name (Legal Business Name): BLOUNT'S MUTUAL DRUG'S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S BROAD ST
EDENTON NC
27932-1933
US

IV. Provider business mailing address

323 S BROAD ST P O BOX 209
EDENTON NC
27932-1933
US

V. Phone/Fax

Practice location:
  • Phone: 252-482-2127
  • Fax:
Mailing address:
  • Phone: 252-482-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1464
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1464
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01464
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1464
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES GORDON BLOUNT SR.
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 252-482-2127