Healthcare Provider Details

I. General information

NPI: 1083083950
Provider Name (Legal Business Name): REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W THURMAN RD
NEW BERN NC
28562-7020
US

IV. Provider business mailing address

1301 COMMERCE DR
NEW BERN NC
28562-2213
US

V. Phone/Fax

Practice location:
  • Phone: 252-631-5444
  • Fax: 252-631-5110
Mailing address:
  • Phone: 252-639-9006
  • Fax: 252-639-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT JOSEPH MCLAUGHLIN JR.
Title or Position: PRESIDENT OWNER
Credential: RHP
Phone: 252-639-9006