Provider Demographics
NPI:1730665035
Name:D REX PHARMACY OF YADKINVILLE, LLC
Entity Type:Organization
Organization Name:D REX PHARMACY OF YADKINVILLE, LLC
Other - Org Name:D-REX PHARMACY YADKINVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-518-1245
Mailing Address - Street 1:207 ASH ST STE A
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-6809
Mailing Address - Country:US
Mailing Address - Phone:336-518-1245
Mailing Address - Fax:336-518-1246
Practice Address - Street 1:207 ASH ST STE A
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6809
Practice Address - Country:US
Practice Address - Phone:336-518-1245
Practice Address - Fax:336-518-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730665035Medicaid