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General NPI Number Information
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NPI Number | 1720007610
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Entity Type | Organization
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Legal Business Name | REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 2680 HENDERSON DR UNIT 1
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5296
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Country | US
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Telephone | 910-455-9982
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Fax | 910-455-9588
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Provider Business Mailing Address
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Address Line | 1301 COMMERCE DR
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City | NEW BERN
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State | NC
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Zip | 28562-2213
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Country | US
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Telephone | 252-639-9006
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Fax | 252-638-9005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT JOSEPH MCLAUGHLIN JR.
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Credential | RPH
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Telephone | 252-639-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 4913000002
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 4913000002
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 08117
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License Number State | NC
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