Healthcare Provider Details

I. General information

NPI: 1346335502
Provider Name (Legal Business Name): RIPLEY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 N SOUTH ST
MOUNT AIRY NC
27030-3532
US

IV. Provider business mailing address

364 N SOUTH ST
MOUNT AIRY NC
27030-3532
US

V. Phone/Fax

Practice location:
  • Phone: 336-789-5050
  • Fax: 336-786-7169
Mailing address:
  • Phone: 336-789-5050
  • Fax: 336-786-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10128
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier010102545
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 2
Identifier0865584
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier3422499
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: ADAM RIPLEY
Title or Position: PRESIDENT
Credential: PHRMD
Phone: 336-835-3131