Healthcare Provider Details

I. General information

NPI: 1760773337
Provider Name (Legal Business Name): DENTON PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 D BROAD ST
ORIENTAL NC
28571
US

IV. Provider business mailing address

703 ASHBURTON DR
GREENVILLE NC
27858-0674
US

V. Phone/Fax

Practice location:
  • Phone: 252-249-2740
  • Fax: 252-249-2749
Mailing address:
  • Phone: 252-249-2740
  • Fax: 252-249-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11031
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number11031
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11031
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11031
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number11031
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number11031
License Number StateNC

VIII. Authorized Official

Name: MR. EDWARD DENTON
Title or Position: PRESIDENT
Credential: RPH
Phone: 252-249-2740