Provider Demographics
NPI:1528209137
Name:COSTWISE PHARMACY INC
Entity Type:Organization
Organization Name:COSTWISE PHARMACY INC
Other - Org Name:ONEALS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-943-1913
Mailing Address - Street 1:275 PAMLICO ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1417
Mailing Address - Country:US
Mailing Address - Phone:252-943-1913
Mailing Address - Fax:252-944-2828
Practice Address - Street 1:712 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2648
Practice Address - Country:US
Practice Address - Phone:252-809-4288
Practice Address - Fax:252-809-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119343OtherPK