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	00005158	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4446072	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720427180
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	:	4470 N ROAN ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4922
Country	:	US
Telephone Number	:	423-282-0055
Fax Number	:	423-282-0467

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	02/08/2022

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Directions to “INGLES MARKETS INC ” Practice Location

Language	Start Address	Practice Location

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