Provider Demographics
NPI:1174847636
Name:ANGIER DISCOUNT DRUG OF NC LLC
Entity Type:Organization
Organization Name:ANGIER DISCOUNT DRUG OF NC LLC
Other - Org Name:ANGIER DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-591-8709
Mailing Address - Street 1:PO BOX 1837
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-1837
Mailing Address - Country:US
Mailing Address - Phone:919-639-9623
Mailing Address - Fax:919-639-9670
Practice Address - Street 1:253 N RALIEGH STREET
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501
Practice Address - Country:US
Practice Address - Phone:919-639-9623
Practice Address - Fax:919-639-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC105603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3419478OtherNCPDP PROVIDER IDENTIFICATION NUMBER