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General NPI Number Information
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NPI Number | 1770824989
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Entity Type | Organization
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Legal Business Name | MAST DRUG CO., INC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 307 WEST BLVD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-2145
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Country | US
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Telephone | 252-792-1015
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Fax | 252-792-2174
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Provider Business Mailing Address
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Address Line | 1910 ROSS MILL RD
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City | HENDERSON
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State | NC
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Zip | 27537-8789
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Country | US
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Telephone | 252-438-3112
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Fax | 252-492-4096
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Authorized Official
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Title or Position | ADM. MGR.
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Name | POLLY D. BEAL
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Credential |
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Telephone | 252-438-3112
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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 | 03766
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License Number State | NC
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