Provider Demographics
NPI:1497769848
Name:INNES STREET DRUG CO INC
Entity Type:Organization
Organization Name:INNES STREET DRUG CO INC
Other - Org Name:HOME HEALTH CARE OF SALISBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-2431
Mailing Address - Street 1:PO BOX 4065
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-4065
Mailing Address - Country:US
Mailing Address - Phone:704-636-2431
Mailing Address - Fax:704-633-1893
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-636-2431
Practice Address - Fax:704-633-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5608332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701592Medicaid
NC7701592Medicaid