Provider Demographics
NPI:1760595573
Name:MOREHEAD CITY DRUG CO
Entity Type:Organization
Organization Name:MOREHEAD CITY DRUG CO
Other - Org Name:BEAUFORT DRUG CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ATON
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-726-2106
Mailing Address - Street 1:1704 ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4040
Mailing Address - Country:US
Mailing Address - Phone:252-726-2106
Mailing Address - Fax:252-726-4457
Practice Address - Street 1:1404 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-728-2006
Practice Address - Fax:252-728-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0165134Medicaid
NC0165134Medicaid
NC5766040002Medicare NSC