=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679499453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENTRY DRUG CENTER 4 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2026
-----------------------------------------------------
Last Update Date | 06/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5011 FALLSTON RD
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-538-3021
-----------------------------------------------------
Fax | 704-538-0224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5011 FALLSTON RD
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-538-3021
-----------------------------------------------------
Fax | 704-538-0224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH/OWNER
-----------------------------------------------------
Name | TODD EUGENE PIGG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-735-2551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------