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General NPI Number Information
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NPI Number | 1437241791
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Entity Type | Organization
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Legal Business Name | MUTUAL DRUG,INC.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/17/2007
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Provider Practice Location Address
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Address Line | 314 WOOD AVENUE E. PO DRAWER M
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City | BIG STONE GAP
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State | VA
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Zip | 24219-0210
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Country | US
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Telephone | 276-523-1123
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Fax | 276-523-4534
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Provider Business Mailing Address
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Address Line | 314 WOOD AVENUE E. PO DRAWER M
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City | BIG STONE GAP
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State | VA
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Zip | 24219-0210
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Country | US
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Telephone | 276-523-1123
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Fax | 276-523-4534
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD ALAN CARLTON
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Credential | PHARM.D.
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Telephone | 276-523-1123
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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 | 0201000502
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License Number State | VA
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