Provider Demographics
NPI:1164644969
Name:INGLES MARKETS INC
Entity Type:Organization
Organization Name:INGLES MARKETS INC
Other - Org Name:INGLES PHARMACY #121
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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 1:2630 CONNELLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-9227
Practice Address - Country:US
Practice Address - Phone:828-726-6027
Practice Address - Fax:828-726-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC095283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0145540Medicaid
NC3408499OtherNCPDP
NC7705290Medicaid
NC3408499OtherNCPDP
NC0145540Medicaid