=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447276506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICINE BOX PHARMACY OF RUTHERFORDTON, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 CHARLOTTE RD
-----------------------------------------------------
City | RUTHERFORDTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28139-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-287-7117
-----------------------------------------------------
Fax | 828-287-7649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CHARLOTTE RD
-----------------------------------------------------
City | RUTHERFORDTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28139-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-287-7117
-----------------------------------------------------
Fax | 828-287-7649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | MRS. LAURA SMITH HODGE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 828-287-7117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 07481
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------