Healthcare Provider Details

I. General information

NPI: 1639111453
Provider Name (Legal Business Name): INNES ST DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S MAIN ST
SALISBURY NC
28144-4942
US

IV. Provider business mailing address

PO BOX 4065
SALISBURY NC
28145-4065
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-4521
  • Fax: 704-633-1893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05608
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES FULLER
Title or Position: PRESIDENT
Credential:
Phone: 704-633-4521