Provider Demographics
NPI:1356375273
Name:SENTRY DRUG CENTER 11
Entity type:Organization
Organization Name:SENTRY DRUG CENTER 11
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CFO
Authorized Official - Phone:704-735-2551
Mailing Address - Street 1:2622 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4319
Mailing Address - Country:US
Mailing Address - Phone:704-735-2551
Mailing Address - Fax:704-735-6222
Practice Address - Street 1:2622 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4319
Practice Address - Country:US
Practice Address - Phone:704-735-2551
Practice Address - Fax:704-735-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
NC028943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0555400Medicaid
NC7703524Medicaid
NC4380660001Medicare NSC