Provider Demographics
NPI:1598700718
Name:NORTHWESTERN DRUG CO INC
Entity Type:Organization
Organization Name:NORTHWESTERN DRUG CO INC
Other - Org Name:TOWN AND COUNTRY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ICARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-632-2278
Mailing Address - Street 1:255 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3048
Mailing Address - Country:US
Mailing Address - Phone:828-632-2278
Mailing Address - Fax:828-632-6044
Practice Address - Street 1:53 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2540
Practice Address - Country:US
Practice Address - Phone:828-632-2278
Practice Address - Fax:828-632-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NC014353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0025130Medicaid
NC7702601Medicaid
2067500OtherPK
0953080002Medicare NSC