Provider Demographics
NPI:1982797114
Name:CLARKTON DRUG INC.
Entity Type:Organization
Organization Name:CLARKTON DRUG INC.
Other - Org Name:CLARKTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-647-0437
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-0816
Mailing Address - Country:US
Mailing Address - Phone:910-647-0437
Mailing Address - Fax:910-647-0696
Practice Address - Street 1:80 E GREEN ST
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-5003
Practice Address - Country:US
Practice Address - Phone:910-647-0437
Practice Address - Fax:910-647-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC081563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2071719OtherPK
NC1982797114Medicaid
1185480001Medicare NSC