Provider Demographics
NPI:1104375625
Name:INGLES MARKETS INC
Entity Type:Organization
Organization Name:INGLES MARKETS INC
Other - Org Name:INGLES PHARMACY #024
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-669-2941
Mailing Address - Street 1:PO BOX 603941
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3941
Mailing Address - Country:US
Mailing Address - Phone:828-669-2941
Mailing Address - Fax:828-669-3685
Practice Address - Street 1:863 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2205
Practice Address - Country:US
Practice Address - Phone:828-665-9361
Practice Address - Fax:828-665-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4347600112Medicare NSC
2800131Medicare PIN