Provider Demographics
NPI:1174718175
Name:INGLES MARKETS INC.
Entity type:Organization
Organization Name:INGLES MARKETS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-669-2941
Mailing Address - Street 1:PO BOX 603941
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3941
Mailing Address - Country:US
Mailing Address - Phone:828-669-2941
Mailing Address - Fax:828-669-3685
Practice Address - Street 1:1000 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-2204
Practice Address - Country:US
Practice Address - Phone:706-376-3212
Practice Address - Fax:706-376-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0093813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1156252OtherNCPDP
GA060359788AMedicaid
GA202G733740Medicare PIN
GA1156252OtherNCPDP