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General NPI Number Information
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NPI Number | 1962418616
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Entity Type | Organization
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Legal Business Name | L
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1985 STARTOWN RD
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City | HICKORY
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State | NC
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Zip | 28602-8307
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Country | US
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Telephone | 828-328-1169
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Fax | 828-327-4756
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Provider Business Mailing Address
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Address Line | 1985 STARTOWN RD
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City | HICKORY
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State | NC
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Zip | 28602-8307
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Country | US
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Telephone | 828-328-1169
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Fax | 828-327-4756
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Authorized Official
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Title or Position | OWNER
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Name | JOHN KESSEL
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Credential | MD
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Telephone | 820-327-4745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05735
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License Number State | NC
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