Provider Demographics
NPI:1760561179
Name:BELMONT'S DRUG STORE, INC.
Entity Type:Organization
Organization Name:BELMONT'S DRUG STORE, INC.
Other - Org Name:BELMONT'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KENLEY
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-829-9897
Mailing Address - Street 1:403 CATAWBA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3311
Mailing Address - Country:US
Mailing Address - Phone:704-829-9897
Mailing Address - Fax:704-829-7857
Practice Address - Street 1:403 CATAWBA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3311
Practice Address - Country:US
Practice Address - Phone:704-829-9897
Practice Address - Fax:704-829-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03-23-218OtherNC EMPLOYER ID
NC0366245Medicaid
NC3440877OtherNCPDP/NABP
NC08291OtherPHARMACY PERMIT
NC08291OtherPHARMACY PERMIT
NC08291OtherPHARMACY PERMIT