Provider Demographics
NPI:1710085691
Name:CHOCOWINITY PHARMACY INC
Entity Type:Organization
Organization Name:CHOCOWINITY PHARMACY INC
Other - Org Name:ONEALS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:292-943-1913
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-0005
Mailing Address - Country:US
Mailing Address - Phone:252-946-4000
Mailing Address - Fax:
Practice Address - Street 1:685 HWY 33 EAST
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817
Practice Address - Country:US
Practice Address - Phone:252-946-4000
Practice Address - Fax:252-946-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC077173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703308Medicaid
2068808OtherPK