Provider Demographics
NPI: | 1417240334 |
---|---|
Name: | TAS DRUG WEST LINCOLN, INC. |
Entity Type: | Organization |
Organization Name: | TAS DRUG WEST LINCOLN, INC. |
Other - Org Name: | TAS DRUG WEST LINCOLN |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | EASON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHARMACIST |
Authorized Official - Phone: | 704-435-5082 |
Mailing Address - Street 1: | 500 W CHURCH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | CHERRYVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28021-2812 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-435-5082 |
Mailing Address - Fax: | 704-435-4184 |
Practice Address - Street 1: | 4417 WEST NC HWY 27 |
Practice Address - Street 2: | |
Practice Address - City: | VALE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28168-9656 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-435-5082 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-05-25 |
Last Update Date: | 2011-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 11037 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |