Provider Demographics
NPI:1881648442
Name:DDP PHARMACY, INC
Entity Type:Organization
Organization Name:DDP PHARMACY, INC
Other - Org Name:DRUGCO DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-7010
Mailing Address - Street 1:107 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4911
Mailing Address - Country:US
Mailing Address - Phone:252-537-7010
Mailing Address - Fax:252-410-0743
Practice Address - Street 1:107 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4911
Practice Address - Country:US
Practice Address - Phone:252-537-7010
Practice Address - Fax:252-410-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05053332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700278Medicaid
NC7700278Medicaid