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General NPI Number Information
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NPI Number | 1285172197
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Entity Type | Organization
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Legal Business Name | BLSRPH, INC
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Dates
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Enumeration Date | 02/11/2017
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 108 E OLD HIGHWAY 74 76
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City | LAKE WACCAMAW
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State | NC
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Zip | 28450-2512
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Country | US
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Telephone | 910-646-3435
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Fax | 910-646-4056
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | LAKE WACCAMAW
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State | NC
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Zip | 28450-0148
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Country | US
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Telephone | 910-646-3435
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Fax | 910-646-4056
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | BENJAMIN LEWIS SAULS
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Credential | R.PH
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Telephone | 910-646-3435
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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 | 13173
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License Number State | NC
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