Provider Demographics
NPI:1659516425
Name:W C ROSE DRUG STORE INC
Entity Type:Organization
Organization Name:W C ROSE DRUG STORE INC
Other - Org Name:THOMAS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CPED
Authorized Official - Phone:252-237-1188
Mailing Address - Street 1:309-B NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-1188
Mailing Address - Fax:252-206-1990
Practice Address - Street 1:309-B NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-1188
Practice Address - Fax:252-206-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04464333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047V4OtherBCBSNC - IMMUNIZATION
NC0985317Medicaid
NC3401697OtherNCPDP
NC2340306Medicare PIN
NC0985317Medicaid