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General NPI Number Information
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NPI Number | 1568731594
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Entity Type | Organization
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Legal Business Name | INNES STREET DRUG CO. INC. #3
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 1706 W INNES ST
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City | SALISBURY
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State | NC
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Zip | 28144-2552
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Country | US
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Telephone | 704-636-1712
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Fax | 704-637-0324
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Provider Business Mailing Address
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Address Line | 1706 W INNES ST
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City | SALISBURY
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State | NC
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Zip | 28144-2552
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Country | US
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Telephone | 704-636-1712
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Fax | 704-637-0324
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Authorized Official
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Title or Position | VICE-PRESIDENT/ PHARMACIST-MANAGER
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Name | MR. STEPHEN WELDON FULLER
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Credential |
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Telephone | 704-636-1712
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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 | 05609
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License Number State | NC
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