Provider Demographics
NPI:1164560157
Name:PUTNAM DRUG INC
Entity Type:Organization
Organization Name:PUTNAM DRUG INC
Other - Org Name:CENTRAL DRUG OF BESSEMER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-629-2163
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BESSEMER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28016-0027
Mailing Address - Country:US
Mailing Address - Phone:704-629-3889
Mailing Address - Fax:704-629-6340
Practice Address - Street 1:112 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-2373
Practice Address - Country:US
Practice Address - Phone:704-629-2163
Practice Address - Fax:704-629-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC70213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065184OtherPK
NC0366111Medicaid