Healthcare Provider Details

I. General information

NPI: 1619794237
Provider Name (Legal Business Name): DLC APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S STERLING ST
MORGANTON NC
28655-3573
US

IV. Provider business mailing address

PO BOX 580
NEWLAND NC
28657-0580
US

V. Phone/Fax

Practice location:
  • Phone: 828-433-6353
  • Fax:
Mailing address:
  • Phone: 803-417-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON LISK
Title or Position: PHARMACIST MANAGER
Credential: PHARMD
Phone: 803-417-0439