Provider Demographics
NPI:1518362011
Name:SENTRY DRUG CENTER 3, LLC DBA FAMILYMED PHARMACY
Entity Type:Organization
Organization Name:SENTRY DRUG CENTER 3, LLC DBA FAMILYMED PHARMACY
Other - Org Name:FAMILYMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-735-2551
Mailing Address - Street 1:2622 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4319
Mailing Address - Country:US
Mailing Address - Phone:704-735-2551
Mailing Address - Fax:704-735-6222
Practice Address - Street 1:110 E DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2051
Practice Address - Country:US
Practice Address - Phone:704-263-0810
Practice Address - Fax:704-263-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X, 3336C0004X, 3336S0011X
NC06038333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365973Medicaid
NC0365973Medicaid