Provider Demographics
NPI:1639420623
Name:ONEALS DRUG STORE OF NEWPORT INC
Entity Type:Organization
Organization Name:ONEALS DRUG STORE OF NEWPORT INC
Other - Org Name:ONEALS DRUG STORE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:P
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:252-943-2643
Mailing Address - Street 1:129 NINE FOOT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 NINE FOOT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9251
Practice Address - Country:US
Practice Address - Phone:252-223-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114014081OtherRX NPI
6722570001Medicare NSC