Provider Demographics
NPI:1548570955
Name:CLINIC DRUG INC.
Entity Type:Organization
Organization Name:CLINIC DRUG INC.
Other - Org Name:CLINIC DRUG INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CZARKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-584-0741
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:GLEN ALPINE
Mailing Address - State:NC
Mailing Address - Zip Code:28628-0836
Mailing Address - Country:US
Mailing Address - Phone:828-584-0741
Mailing Address - Fax:828-584-0744
Practice Address - Street 1:106 LINVILLE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-2806
Practice Address - Country:US
Practice Address - Phone:828-584-0741
Practice Address - Fax:828-584-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC106943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548570955Medicaid
2128004OtherPK