MEDICARE: INGLES MARKETS 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	PHRE009523	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1588817274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGLES MARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 603941
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3941
Country	:	US
Telephone Number	:	828-669-2941
Fax Number	:	828-669-3685

Provider Business Practice Location Address
First Line	:	1817 DALLAS- NEBO RD
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134
Country	:	US
Telephone Number	:	678-383-8717
Fax Number	:	678-383-8716

Authorized Official
Title or Position	:	VP OF PHARMACY
Name	:	MR. STEPHEN V CUCCHI
Credential	:	RPH
Telephone Number	:	828-669-2941

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	04/10/2020

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Directions to “INGLES MARKETS INC ” Practice Location

Language	Start Address	Practice Location

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