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General NPI Number Information
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NPI Number | 1396842357
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Entity Type | Organization
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Legal Business Name | BLOUNT'S MUTUAL DRUG'S INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 323 S BROAD ST
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City | EDENTON
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State | NC
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Zip | 27932-1933
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Country | US
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Telephone | 252-482-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 323 S BROAD ST P O BOX 209
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City | EDENTON
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State | NC
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Zip | 27932-1933
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Country | US
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Telephone | 252-482-2127
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES GORDON BLOUNT SR.
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Credential | R.PH.
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Telephone | 252-482-2127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 1464
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1464
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1464
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 01464
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License Number State | NC
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