Provider Demographics
NPI:1619287653
Name:STOKES PHARMACY
Entity Type:Organization
Organization Name:STOKES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FULK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-983-3118
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-0446
Mailing Address - Country:US
Mailing Address - Phone:336-983-3118
Mailing Address - Fax:336-983-2933
Practice Address - Street 1:607B S MAIN ST
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9016
Practice Address - Country:US
Practice Address - Phone:336-983-3118
Practice Address - Fax:336-983-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOKES PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0855049Medicaid