Provider Demographics
NPI:1710328315
Name:SENTRY DRUG CENTER 16 INC
Entity Type:Organization
Organization Name:SENTRY DRUG CENTER 16 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-735-2551
Mailing Address - Street 1:1446 E GASTON ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4412
Mailing Address - Country:US
Mailing Address - Phone:704-732-1194
Mailing Address - Fax:704-732-9709
Practice Address - Street 1:1446 E GASTON ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4412
Practice Address - Country:US
Practice Address - Phone:704-732-1194
Practice Address - Fax:704-732-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0555185Medicaid
NC0139480001Medicare NSC