Provider Demographics
NPI:1407372048
Name:DAVIS DRUG COMPANY OF KENLY, INC.
Entity Type:Organization
Organization Name:DAVIS DRUG COMPANY OF KENLY, INC.
Other - Org Name:DAVIS DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:919-934-9111
Mailing Address - Street 1:12330 NC HIGHWAY 210 STE 102
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-5800
Mailing Address - Country:US
Mailing Address - Phone:919-934-9111
Mailing Address - Fax:919-934-9991
Practice Address - Street 1:12330 NC HIGHWAY 210 STE 102
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-5800
Practice Address - Country:US
Practice Address - Phone:919-934-9111
Practice Address - Fax:919-934-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy