Healthcare Provider Details

I. General information

NPI: 1962584755
Provider Name (Legal Business Name): ROCK DRUG OF VALDESE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAIN ST W
VALDESE NC
28690-2835
US

IV. Provider business mailing address

PO BOX 248 240 MAIN ST WEST
VALDESE NC
28690-2835
US

V. Phone/Fax

Practice location:
  • Phone: 828-879-9812
  • Fax: 828-874-8915
Mailing address:
  • Phone: 828-879-9812
  • Fax: 828-874-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11094
License Number StateNC

VIII. Authorized Official

Name: WILLIAM BRUCE CANNON
Title or Position: MANAGER LLC
Credential: RPH--MGR LLC
Phone: 828-879-9812