Provider Demographics
NPI:1891888020
Name:ELVINGTON DRUG LLC
Entity Type:Organization
Organization Name:ELVINGTON DRUG LLC
Other - Org Name:ELVINGTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-649-7721
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439-0098
Mailing Address - Country:US
Mailing Address - Phone:910-649-7721
Mailing Address - Fax:910-649-6515
Practice Address - Street 1:1126 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439
Practice Address - Country:US
Practice Address - Phone:910-649-7721
Practice Address - Fax:910-649-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3405974OtherNCPDP PROVIDER IDENTIFICATION NUMBER