Provider Demographics
NPI:1841739877
Name:TODDS PHARMACY OF GATES CO INC
Entity Type:Organization
Organization Name:TODDS PHARMACY OF GATES CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-357-1800
Mailing Address - Street 1:504 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 MAIN ST.
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938
Practice Address - Country:US
Practice Address - Phone:252-357-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TODDS PHARMACY OF GATES CO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0375105Medicaid
NC5026850001Medicare PIN