MEDICINE MART LTC LLC NPI 1174639041

NPI Information

MEDICINE MART LTC, LLC is a long term care pharmacy pharmacy in Tabor City, NC. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. MEDICINE MART LTC, LLC NPI is 1174639041. The provider is registered as an organization entity type.

The provider's business location address is:

214 S MAIN ST
TABOR CITY, NC
ZIP 28463-904
Phone: (910) 653-6804
Fax: (910) 653-4915

The provider's authorized official is Sterling G Koonce .
The authorized official title is Managing Agent and has the following contact phone number (910) 653-6805.

The CLIA number assigned to this NPI record is 34D2211377 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/22/2006 and was last updated on 7/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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