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General NPI Number Information
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NPI Number | 1093005217
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Entity Type | Organization
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Legal Business Name | REALO DISCOUNT DRUG OF POLLOCKSVILLE
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 9041 HWY 17
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City | POLLOCKSVILLE
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State | NC
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Zip | 28573-0027
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Country | US
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Telephone | 252-224-0404
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Fax | 252-224-0406
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | POLLOCKSVILLE
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State | NC
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Zip | 28573-0027
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Country | US
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Telephone | 252-224-0404
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Fax | 252-224-0406
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. PAIGE H KILLINGSWORTH
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Credential | PHARM.D.
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Telephone | 252-229-8124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10999
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License Number State | NC
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