Provider Demographics
NPI:1013251628
Name:MAST DRUG CO., INC
Entity type:Organization
Organization Name:MAST DRUG CO., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM. MGR
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-438-3112
Mailing Address - Street 1:1910 ROSS MILL RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-8789
Mailing Address - Country:US
Mailing Address - Phone:252-438-3112
Mailing Address - Fax:252-492-4096
Practice Address - Street 1:501 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4102
Practice Address - Country:US
Practice Address - Phone:888-294-4955
Practice Address - Fax:252-438-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC017353336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy