Provider Demographics
NPI:1932315744
Name:DITMORE DRUGS
Entity Type:Organization
Organization Name:DITMORE DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WM
Authorized Official - Middle Name:
Authorized Official - Last Name:DITMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:826-479-6461
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771
Mailing Address - Country:US
Mailing Address - Phone:828-479-6461
Mailing Address - Fax:828-479-3819
Practice Address - Street 1:107 US HWY 129
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-0576
Practice Address - Country:US
Practice Address - Phone:828-479-6461
Practice Address - Fax:828-479-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03850839Medicaid
NC06591800001Medicare ID - Type Unspecified