Provider Demographics
NPI:1407104284
Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Entity Type:Organization
Organization Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Other - Org Name:REALO DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-639-9006
Mailing Address - Street 1:1301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2213
Mailing Address - Country:US
Mailing Address - Phone:252-639-9006
Mailing Address - Fax:252-639-9005
Practice Address - Street 1:322 PRITCHARD RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527
Practice Address - Country:US
Practice Address - Phone:919-359-9164
Practice Address - Fax:919-359-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6689380002332BC3200X
NC6431660002332BX2000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0515695Medicaid
NC11323OtherNCBOP
NC4913000012Medicare NSC