Provider Demographics
NPI:1609192772
Name:CAROLINA DISCOUNT DRUG STORE, LLC
Entity Type:Organization
Organization Name:CAROLINA DISCOUNT DRUG STORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JACOBS
Authorized Official - Last Name:GHAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-272-6400
Mailing Address - Street 1:201 LIVERMORE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7322
Mailing Address - Country:US
Mailing Address - Phone:910-272-6400
Mailing Address - Fax:
Practice Address - Street 1:741 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5507
Practice Address - Country:US
Practice Address - Phone:910-734-7286
Practice Address - Fax:910-521-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty