Provider Demographics
NPI:1427180454
Name:DRUG STORE INC
Entity Type:Organization
Organization Name:DRUG STORE INC
Other - Org Name:BRATTONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PIC
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALAPINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:903-731-4734
Mailing Address - Street 1:PO BOX 1985
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1985
Mailing Address - Country:US
Mailing Address - Phone:903-731-4734
Mailing Address - Fax:903-731-4305
Practice Address - Street 1:2305 W OAK ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4063
Practice Address - Country:US
Practice Address - Phone:903-731-4734
Practice Address - Fax:903-731-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX152753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4587866OtherNCPDP PROVIDER IDENTIFICATION NUMBER