Healthcare Provider Details

I. General information

NPI: 1891892733
Provider Name (Legal Business Name): HAW RIVER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E MAIN ST
HAW RIVER NC
27258-9644
US

IV. Provider business mailing address

740 E MAIN ST
HAW RIVER NC
27258-9644
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-0202
  • Fax: 336-578-0266
Mailing address:
  • Phone: 336-578-0202
  • Fax: 336-578-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05110
License Number StateNC

VIII. Authorized Official

Name: RONALD SMITH
Title or Position: PRES/PIC
Credential: RPH
Phone: 336-578-0202