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General NPI Number Information
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NPI Number | 1780766576
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Entity Type | Organization
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Legal Business Name | SAM'S DRUG STORE OF ROBESON CO, LLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 925 SEASIDE RD SW UNIT 1
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City | OCEAN ISLE BEACH
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State | NC
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Zip | 28469-6152
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Country | US
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Telephone | 910-774-4600
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Fax | 910-739-7207
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Provider Business Mailing Address
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Address Line | 925 SEASIDE RD SW UNIT 1
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City | OCEAN ISLE BEACH
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State | NC
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Zip | 28469-6152
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Country | US
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Telephone | 910-774-4600
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Fax | 910-739-7207
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WESLEY WATERS III
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Credential | PHARM-D/ RPH
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Telephone | 910-774-4600
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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 | 09819
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License Number State | NC
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