Provider Demographics
NPI:1750832572
Name:SENTRY DRUG CENTER 3, LLC
Entity Type:Organization
Organization Name:SENTRY DRUG CENTER 3, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-263-0810
Mailing Address - Street 1:110 E DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2051
Mailing Address - Country:US
Mailing Address - Phone:704-263-0810
Mailing Address - Fax:704-263-1222
Practice Address - Street 1:110 E DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2051
Practice Address - Country:US
Practice Address - Phone:704-263-0810
Practice Address - Fax:704-263-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0365973Medicaid