Provider Demographics
NPI:1841611167
Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Entity Type:Organization
Organization Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Other - Org Name:REALO EXTENDED CARE PHARMACY
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:28562-2213
Mailing Address - Country:US
Mailing Address - Phone:252-639-9006
Mailing Address - Fax:252-639-9005
Practice Address - Street 1:2129 S GLENBURNIE RD
Practice Address - Street 2:SUITE 12 SOUTH MARKET SQUARE
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5267
Practice Address - Country:US
Practice Address - Phone:252-672-0253
Practice Address - Fax:252-514-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11793OtherNORTH CAROLINA BOARD OF PHARMACY
NC1841611167Medicaid
NC11793OtherNORTH CAROLINA BOARD OF PHARMACY