Provider Demographics
NPI:1407982333
Name:NAN TAUSCHER ENTERPRISES, INC
Entity Type:Organization
Organization Name:NAN TAUSCHER ENTERPRISES, INC
Other - Org Name:LOWELL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:TAUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-867-2728
Mailing Address - Street 1:2509 E OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1423
Mailing Address - Country:US
Mailing Address - Phone:704-867-2728
Mailing Address - Fax:
Practice Address - Street 1:2509 E OZARK AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1423
Practice Address - Country:US
Practice Address - Phone:704-867-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC056291835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0366194Medicaid