Provider Demographics
NPI:1649579582
Name:PHYSICIANS DISCOUNT DRUG LLC
Entity Type:Organization
Organization Name:PHYSICIANS DISCOUNT DRUG LLC
Other - Org Name:PHYSICIANS DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-868-2086
Mailing Address - Street 1:741 TILGHMAN DR
Mailing Address - Street 2:STE A
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5507
Mailing Address - Country:US
Mailing Address - Phone:910-230-0662
Mailing Address - Fax:910-230-0664
Practice Address - Street 1:741 TILGHMAN DR
Practice Address - Street 2:STE A
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5507
Practice Address - Country:US
Practice Address - Phone:910-230-0662
Practice Address - Fax:910-230-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3458545OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3458545OtherNCPDP PROVIDER IDENTIFICATION NUMBER