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General NPI Number Information
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NPI Number | 1932240009
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Entity Type | Organization
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Legal Business Name | CLINIC DRUG STORE, INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 LINVILLE STREET
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City | GLEN ALPINE
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State | NC
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Zip | 28628-0836
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Country | US
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Telephone | 828-584-0741
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Fax | 828-584-0744
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Provider Business Mailing Address
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Address Line | 106 LINVILLE ST PO BOX 836
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City | GLEN ALPINE
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State | NC
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Zip | 28628
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Country | US
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Telephone | 828-584-0741
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Fax | 828-584-0744
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN BENNETT
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Credential | RPH
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Telephone | 828-584-0741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 05572
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License Number State | NC
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