=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386659233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INGLES MARKETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 08/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 HIGHWAY 9
-----------------------------------------------------
City | INMAN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29349-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-814-3643
-----------------------------------------------------
Fax | 864-814-3711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 603941
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-669-2941
-----------------------------------------------------
Fax | 828-669-3685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF PHARMAC Y
-----------------------------------------------------
Name | MR. STEPHEN V CUCCHI
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 828-669-2941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 50008376
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------