Provider Demographics
NPI:1528211026
Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC
Entity Type:Organization
Organization Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-514-0461
Mailing Address - Street 1:1301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2213
Mailing Address - Country:US
Mailing Address - Phone:252-639-9006
Mailing Address - Fax:252-639-9005
Practice Address - Street 1:1301 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2213
Practice Address - Country:US
Practice Address - Phone:252-639-9006
Practice Address - Fax:252-639-9005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2801191OtherMEDICARE IMMUNIZATION BILLER NUMBER