Provider Demographics
NPI:1558307447
Name:ASHWORTH REXALL DRUGS INC
Entity Type:Organization
Organization Name:ASHWORTH REXALL DRUGS INC
Other - Org Name:ASHWORTH DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:919-467-1877
Mailing Address - Street 1:105 W CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3331
Mailing Address - Country:US
Mailing Address - Phone:919-467-1877
Mailing Address - Fax:919-467-3303
Practice Address - Street 1:105 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3331
Practice Address - Country:US
Practice Address - Phone:919-467-1877
Practice Address - Fax:919-467-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC014903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0925016Medicaid
2067858OtherPK
2067858OtherPK