Provider Demographics
NPI:1255896015
Name:ANDERSONS DRUG STORE LLC
Entity type:Organization
Organization Name:ANDERSONS DRUG STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENESE
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:PEED
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:910-862-8411
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0730
Mailing Address - Country:US
Mailing Address - Phone:910-862-8411
Mailing Address - Fax:910-862-8775
Practice Address - Street 1:206 S. POPLAR ST.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-8411
Practice Address - Fax:910-862-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies