Healthcare Provider Details

I. General information

NPI: 1568514677
Provider Name (Legal Business Name): CAJAHS MTN DISCOUNT DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 CONNELLY SPRINGS RD
LENOIR NC
28645-7830
US

IV. Provider business mailing address

2006 CONNELLY SPRINGS RD
LENOIR NC
28645-7830
US

V. Phone/Fax

Practice location:
  • Phone: 828-726-8632
  • Fax: 828-726-8661
Mailing address:
  • Phone: 828-726-8632
  • Fax: 828-726-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5655
License Number StateNC

VIII. Authorized Official

Name: MR. ARCHIE MONROE DAVIS JR.
Title or Position: PRESIDENT
Credential: RPH
Phone: 828-726-8632