MEDICARE: WALNUT COVE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	5086	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	Q492110001	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3416321	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487755807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALNUT COVE PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 537
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-0537
Country	:	US
Telephone Number	:	336-591-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 N MAIN ST
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-9200
Country	:	US
Telephone Number	:	336-591-7171
Fax Number	:	336-591-7936

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD WATTS
Credential	:	RPH
Telephone Number	:	336-591-7171

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	10/26/2016

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Directions to “WALNUT COVE PHARMACY INC ” Practice Location

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