Provider Demographics
NPI:1073537494
Name:NORTHWESTERN DRUG CO INC
Entity Type:Organization
Organization Name:NORTHWESTERN DRUG CO INC
Other - Org Name:PEOPLES DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ICARD
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERD PHARMACIST
Authorized Official - Phone:828-632-2271
Mailing Address - Street 1:255 NC HWY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3048
Mailing Address - Country:US
Mailing Address - Phone:828-632-2271
Mailing Address - Fax:828-632-2220
Practice Address - Street 1:255 NC HWY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3048
Practice Address - Country:US
Practice Address - Phone:828-632-2271
Practice Address - Fax:828-632-2220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWESTERN DRUG CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0025015Medicaid
NC7702694Medicaid
3413565OtherNABP
NC0025015Medicaid