Provider Demographics
NPI:1710022595
Name:CLEVELAND DRUG COMPANY, INC
Entity Type:Organization
Organization Name:CLEVELAND DRUG COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-278-4788
Mailing Address - Street 1:11745B STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-9419
Mailing Address - Country:US
Mailing Address - Phone:704-278-4788
Mailing Address - Fax:704-278-4596
Practice Address - Street 1:11745B STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9419
Practice Address - Country:US
Practice Address - Phone:704-278-4788
Practice Address - Fax:704-278-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0805671Medicaid
NC4507300001Medicare ID - Type Unspecified