Provider Demographics
NPI:1184711020
Name:MITCHELL'S DISCOUNT DRUGS, INC
Entity type:Organization
Organization Name:MITCHELL'S DISCOUNT DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-7747
Mailing Address - Street 1:641 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-6137
Mailing Address - Country:US
Mailing Address - Phone:336-623-3136
Mailing Address - Fax:336-623-2218
Practice Address - Street 1:641 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-6137
Practice Address - Country:US
Practice Address - Phone:336-623-3136
Practice Address - Fax:336-623-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0795302Medicaid
NC3405671OtherNABP