Provider Demographics
NPI:1003923673
Name:KOONCE DRUG COMPANY, INC
Entity Type:Organization
Organization Name:KOONCE DRUG COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOONCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-653-6805
Mailing Address - Street 1:112 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1402
Mailing Address - Country:US
Mailing Address - Phone:910-654-4194
Mailing Address - Fax:910-654-4438
Practice Address - Street 1:112 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1402
Practice Address - Country:US
Practice Address - Phone:910-654-4194
Practice Address - Fax:910-654-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245035Medicaid
0905820001Medicare NSC
0905820001Medicare PIN