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General NPI Number Information
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NPI Number | 1538200456
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Entity Type | Organization
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Legal Business Name | SELF MED RX MAIN STREET PHARMACY INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 460 MAIN ST
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City | HIGHLANDS
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State | NC
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Zip | 28741
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Country | US
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Telephone | 828-526-8845
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Fax | 828-526-2367
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Provider Business Mailing Address
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Address Line | PO BOX 6827 C/O SELF MED RX INC
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City | ATLANTA
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State | GA
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Zip | 30315
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Country | US
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Telephone | 800-342-6450
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Fax | 404-614-0322
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES M BENTLEY
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Credential |
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Telephone | 800-342-6450
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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 | 08061
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License Number State | NC
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