Provider Demographics
NPI:1912004847
Name:GUITONS DRUG STORE
Entity Type:Organization
Organization Name:GUITONS DRUG STORE
Other - Org Name:GUITONS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MNGR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-642-4188
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0669
Mailing Address - Country:US
Mailing Address - Phone:910-642-4188
Mailing Address - Fax:910-642-9003
Practice Address - Street 1:801 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4613
Practice Address - Country:US
Practice Address - Phone:910-642-4188
Practice Address - Fax:910-642-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC094573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC245050Medicaid
2067609OtherPK