Provider Demographics
NPI:1568514677
Name:CAJAHS MTN DISCOUNT DRUG
Entity Type:Organization
Organization Name:CAJAHS MTN DISCOUNT DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-726-8632
Mailing Address - Street 1:2006 CONNELLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-7830
Mailing Address - Country:US
Mailing Address - Phone:828-726-8632
Mailing Address - Fax:828-726-8661
Practice Address - Street 1:2006 CONNELLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-7830
Practice Address - Country:US
Practice Address - Phone:828-726-8632
Practice Address - Fax:828-726-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy