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NPI Code Detail

MEDICARE: REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC

MEDICARE: REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, 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
13336C0003XCommunity/Retail Pharmacy07031NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12801191OTHERMEDICARE IMMUNIZATION BILLER NUMBER

General Provider Information

NPI Number : 1528211026
Entity Type Code : Organization
Provider Name (Legal Business Name) : REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC
Provider Business Mailing Address
First Line : 1301 COMMERCE DR
Second Line :
City : NEW BERN
State : NC
Zip : 28562-2213
Country : US
Telephone Number : 252-639-9006
Fax Number : 252-639-9005
Provider Business Practice Location Address
First Line : 1301 COMMERCE DR
Second Line :
City : NEW BERN
State : NC
Zip : 28562-2213
Country : US
Telephone Number : 252-639-9006
Fax Number : 252-639-9005
Authorized Official
Title or Position : PRESIDENT
Name : MR. ROBERT JOSEPH MCLAUGHLIN JR.
Credential : RPH
Telephone Number : 252-514-0461
Provider Enumeration Date : 10/28/2008
Last Update Date : 12/19/2012

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