Healthcare Provider Details

I. General information

NPI: 1871560631
Provider Name (Legal Business Name): DAMERON DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST
TABOR CITY NC
28463
US

IV. Provider business mailing address

100 S MAIN ST
TABOR CITY NC
28463-1910
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-3089
  • Fax: 910-653-5839
Mailing address:
  • Phone: 910-653-3089
  • Fax: 910-653-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00917
License Number StateNC

VIII. Authorized Official

Name: DAVID DAMERON
Title or Position: VICE PRESIDENT/COMPLIANCE OFFICER
Credential:
Phone: 910-653-3089