Provider Demographics
NPI:1932240009
Name:CLINIC DRUG STORE, INC
Entity Type:Organization
Organization Name:CLINIC DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-584-0741
Mailing Address - Street 1:106 LINVILLE ST
Mailing Address - Street 2:PO BOX 836
Mailing Address - City:GLEN ALPINE
Mailing Address - State:NC
Mailing Address - Zip Code:28628
Mailing Address - Country:US
Mailing Address - Phone:828-584-0741
Mailing Address - Fax:828-584-0744
Practice Address - Street 1:106 LINVILLE STREET
Practice Address - Street 2:
Practice Address - City:GLEN ALPINE
Practice Address - State:NC
Practice Address - Zip Code:28628-0836
Practice Address - Country:US
Practice Address - Phone:828-584-0741
Practice Address - Fax:828-584-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty