Provider Demographics
NPI:1750489639
Name:STOKES PHARMACY, INC
Entity Type:Organization
Organization Name:STOKES PHARMACY, INC
Other - Org Name:STOKES PHARMACY OF DANBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-983-3118
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-0244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-7663
Practice Address - Country:US
Practice Address - Phone:336-593-8070
Practice Address - Fax:336-593-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC034533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0855106Medicaid
2068071OtherPK
2068071OtherPK