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General NPI Number Information
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NPI Number | 1598162240
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Entity Type | Organization
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Legal Business Name | EDGECOMBE DRUG INC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1329 TARBORO ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-6070
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Country | US
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Telephone | 252-446-1154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | ROCKY MOUNT
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State | NC
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Zip | 27802-0311
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Country | US
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Telephone | 919-475-8706
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD KOS
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Credential | PHARMD
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Telephone | 919-475-8706
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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 | 12122
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License Number State | NC
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