=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346335494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALMANDS DRUG STORE #1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 11/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S MAIN STREET
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-442-5126
-----------------------------------------------------
Fax | 252-442-8036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O.BOX 311 130 S MAIN STREET
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-442-5126
-----------------------------------------------------
Fax | 252-442-8036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST-MANAGER
-----------------------------------------------------
Name | MRS. CLAIRE SMITH
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 252-442-5126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 01519
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 01519
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 01519
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 01519
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 01519
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------