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
StateLicense IDTaxonomies
NC110373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy