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General NPI Number Information
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NPI Number | 1962704635
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Entity Type | Organization
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Legal Business Name | DAMERON DRUG STORE, INC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 100 S MAIN ST
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City | TABOR CITY
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State | NC
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Zip | 28463-1910
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Country | US
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Telephone | 910-653-3089
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Fax | 910-653-5839
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Provider Business Mailing Address
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Address Line | 100 S MAIN ST
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City | TABOR CITY
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State | NC
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Zip | 28463-1910
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Country | US
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Telephone | 910-653-3089
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Fax | 910-653-5839
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Authorized Official
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Title or Position | PHARMICIST
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Name | KELLY FOWLER LOVETT
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Credential | PHARMD
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Telephone | 910-653-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 00917
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License Number State | NC
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