Provider Demographics
NPI:1578618732
Name:FAIR BLUFF DISCOUNT DRUG, INC
Entity Type:Organization
Organization Name:FAIR BLUFF DISCOUNT DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:MEARES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-649-7555
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439-0346
Mailing Address - Country:US
Mailing Address - Phone:910-649-7555
Mailing Address - Fax:910-649-6424
Practice Address - Street 1:1089 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439
Practice Address - Country:US
Practice Address - Phone:910-649-7555
Practice Address - Fax:910-649-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC048463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245589Medicaid
NC0245589Medicaid
NC0645890001Medicare NSC