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General NPI Number Information
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NPI Number | 1740246677
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Entity Type | Organization
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Legal Business Name | EDEN DRUG, INC.
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 103 W STADIUM DR
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City | EDEN
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State | NC
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Zip | 27288-3329
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Country | US
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Telephone | 336-627-4854
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Fax | 336-627-8925
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Provider Business Mailing Address
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Address Line | 103 W STADIUM DR
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City | EDEN
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State | NC
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Zip | 27288-3329
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Country | US
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Telephone | 336-627-4854
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Fax | 336-627-8925
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Authorized Official
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Title or Position | PRESIDENT, PHARMACIST
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Name | MR. ROBERT L CROUCH
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Credential | RPH, CPP
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Telephone | 336-627-4854
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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 | 09458
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License Number State | NC
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