Provider Demographics
NPI:1174779607
Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Entity type:Organization
Organization Name:REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:252-639-9006
Mailing Address - Street 1:1301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2213
Mailing Address - Country:US
Mailing Address - Phone:252-639-9006
Mailing Address - Fax:252-639-9005
Practice Address - Street 1:1913 E FIRE TOWER RD
Practice Address - Street 2:SUITE K
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4126
Practice Address - Country:US
Practice Address - Phone:252-355-3538
Practice Address - Fax:252-758-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2801191EOtherMEDICARE FLU
2116718OtherPK
NC4913000008Medicare NSC
2116718OtherPK
NC4913000008Medicare NSC