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General NPI Number Information
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NPI Number | 1588917553
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Entity Type | Organization
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Legal Business Name | LOWRY DRUG CO
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 750 HARTNESS RD STE A
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City | STATESVILLE
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State | NC
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Zip | 28677-3400
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Country | US
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Telephone | 704-872-5226
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Fax | 704-873-4050
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Provider Business Mailing Address
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Address Line | 750 HARTNESS RD STE A
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City | STATESVILLE
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State | NC
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Zip | 28677-3400
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Country | US
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Telephone | 704-872-5226
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Fax | 704-873-4050
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Authorized Official
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Title or Position | RPH/PRESIDENT
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Name | MR. FRED WILSON LOWRY JR.
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Credential | RPH
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Telephone | 704-873-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 09240
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License Number State | NC
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