Provider Demographics
NPI:1255463766
Name:RED SPRINGS DRUG COMPANY
Entity type:Organization
Organization Name:RED SPRINGS DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TILLMAN
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-843-4431
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-1512
Mailing Address - Country:US
Mailing Address - Phone:910-843-4431
Mailing Address - Fax:910-843-3978
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1512
Practice Address - Country:US
Practice Address - Phone:910-843-4431
Practice Address - Fax:910-843-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03908333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0785360Medicaid