Provider Demographics
NPI:1598947731
Name:MEDI FARE DRUG CENTER OF EARL, INC D/B/A GRIFFIN DRUG CENTER
Entity Type:Organization
Organization Name:MEDI FARE DRUG CENTER OF EARL, INC D/B/A GRIFFIN DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-739-4721
Mailing Address - Street 1:129 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3447
Mailing Address - Country:US
Mailing Address - Phone:704-739-4721
Mailing Address - Fax:704-739-4722
Practice Address - Street 1:129 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3447
Practice Address - Country:US
Practice Address - Phone:704-739-4721
Practice Address - Fax:704-739-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5077332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702485Medicaid