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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1871370767
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	:	252-514-6182
Fax Number	:	252-514-0464

Provider Business Practice Location Address
First Line	:	3302 BRIDGES ST STE A
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3366
Country	:	US
Telephone Number	:	252-726-7787
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS/DIRECTOR OF HR
Name	:	SYREETA TAYLOR
Credential	:
Telephone Number	:	252-514-6182

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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