Provider Demographics
NPI:1629078886
Name:THUTT ENTERPRISES INC.
Entity Type:Organization
Organization Name:THUTT ENTERPRISES INC.
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:THUTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-527-2106
Mailing Address - Street 1:704-K PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1567
Mailing Address - Country:US
Mailing Address - Phone:252-527-2106
Mailing Address - Fax:252-527-1217
Practice Address - Street 1:704-K PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1567
Practice Address - Country:US
Practice Address - Phone:252-527-2106
Practice Address - Fax:252-527-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04490183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3422590OtherNABP OR NCPDC
NC0545368Medicaid
NC7701179Medicaid
NC7701179Medicaid