Provider Demographics
NPI:1164785796
Name:ZOO CITY DRUG, INC.
Entity Type:Organization
Organization Name:ZOO CITY DRUG, INC.
Other - Org Name:ZOO CITY DRUG, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-495-5100
Mailing Address - Street 1:600 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-9748
Mailing Address - Country:US
Mailing Address - Phone:336-495-5100
Mailing Address - Fax:336-495-5300
Practice Address - Street 1:1204 SHAMROCK RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6947
Practice Address - Country:US
Practice Address - Phone:336-626-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC112713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3460083OtherNCPDP PROVIDER IDENTIFICATION NUMBER