Provider Demographics
NPI:1033203328
Name:TODDS PHARMACY OF GATES COUNTY
Entity Type:Organization
Organization Name:TODDS PHARMACY OF GATES COUNTY
Other - Org Name:TODDS PHARMACY OF GATES COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-357-1800
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0066
Mailing Address - Country:US
Mailing Address - Phone:252-357-1800
Mailing Address - Fax:252-357-5450
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938
Practice Address - Country:US
Practice Address - Phone:252-357-1800
Practice Address - Fax:252-357-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC083283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0375105Medicaid
2069920OtherPK