Provider Demographics
NPI:1083152227
Name:WEAVERVILLE DRUG CO.
Entity Type:Organization
Organization Name:WEAVERVILLE DRUG CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SPRINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-645-3087
Mailing Address - Street 1:3 N MAIN ST
Mailing Address - Street 2:PO BOX 710
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9427
Mailing Address - Country:US
Mailing Address - Phone:828-645-3087
Mailing Address - Fax:828-645-8314
Practice Address - Street 1:3 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9427
Practice Address - Country:US
Practice Address - Phone:828-645-3087
Practice Address - Fax:828-645-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC012703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0115220Medicaid
NC0832330001Medicare NSC