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General NPI Number Information
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NPI Number | 1811578388
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE DRUGS LLC
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1706 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3419
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Country | US
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Telephone | 910-568-3488
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Fax | 910-568-3110
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Provider Business Mailing Address
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Address Line | 1706 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3419
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Country | US
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Telephone | 910-568-3488
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Fax | 910-568-3110
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Authorized Official
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Title or Position | OFFICER
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Name | MR. SRIDHAR GOTTIPATI
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Credential | BS IN PHARMACY
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Telephone | 919-986-2547
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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 |
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License Number State |
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