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General NPI Number Information
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NPI Number | 1144366170
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Entity Type | Organization
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Legal Business Name | MARTINS DRUG STORE INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 24 PARK ST
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City | CANTON
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State | NC
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Zip | 28716-4428
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Country | US
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Telephone | 828-648-2321
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Fax | 828-648-2322
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Provider Business Mailing Address
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Address Line | 24 PARK ST
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City | CANTON
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State | NC
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Zip | 28716-4428
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Country | US
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Telephone | 828-648-2321
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Fax | 828-648-2322
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Authorized Official
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Title or Position | PHARMACIST
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Name | SAM BURRUS
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Credential |
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Telephone | 828-648-2321
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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 | 02960
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License Number State | NC
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