Provider Demographics
NPI:1023040888
Name:ALCYONE RETAIL CORP.
Entity Type:Organization
Organization Name:ALCYONE RETAIL CORP.
Other - Org Name:FOOT SOLUTIONS OF CHARLOTTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:STERR
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:704-335-4070
Mailing Address - Street 1:5912 WOODLEIGH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8524
Mailing Address - Country:US
Mailing Address - Phone:704-335-4070
Mailing Address - Fax:704-334-7040
Practice Address - Street 1:1235 EAST BLVD STE K
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5876
Practice Address - Country:US
Practice Address - Phone:704-335-4070
Practice Address - Fax:704-334-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5097120001Medicare ID - Type UnspecifiedMEDICARE NUMBER