Provider Demographics
NPI:1790111961
Name:REALO DISCOUNT DRUG STORES OF ENC, INC
Entity Type:Organization
Organization Name:REALO DISCOUNT DRUG STORES OF ENC, INC
Other - Org Name:REALO DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-639-9006
Mailing Address - Street 1:1301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-639-9006
Mailing Address - Fax:252-639-9005
Practice Address - Street 1:5655 S NC 41 HWY
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466
Practice Address - Country:US
Practice Address - Phone:910-285-1120
Practice Address - Fax:910-285-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11618333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11618OtherNCBOP
NC1790111961Medicaid
NCC978OtherMEDICARE FLU
NCC978OtherMEDICARE FLU