Provider Demographics
NPI:1396842357
Name:BLOUNT'S MUTUAL DRUG'S INC
Entity Type:Organization
Organization Name:BLOUNT'S MUTUAL DRUG'S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-482-2127
Mailing Address - Street 1:323 S BROAD ST
Mailing Address - Street 2:P O BOX 209
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1933
Mailing Address - Country:US
Mailing Address - Phone:252-482-2127
Mailing Address - Fax:
Practice Address - Street 1:323 S BROAD ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1933
Practice Address - Country:US
Practice Address - Phone:252-482-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1464332B00000X, 332BP3500X, 335E00000X
NC014643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0215004Medicaid
NC0215004Medicaid