Provider Demographics
NPI:1447276506
Name:MEDICINE BOX PHARMACY OF RUTHERFORDTON, INC.
Entity type:Organization
Organization Name:MEDICINE BOX PHARMACY OF RUTHERFORDTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-287-7117
Mailing Address - Street 1:200 CHARLOTTE RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2914
Mailing Address - Country:US
Mailing Address - Phone:828-287-7117
Mailing Address - Fax:828-287-7649
Practice Address - Street 1:200 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2914
Practice Address - Country:US
Practice Address - Phone:828-287-7117
Practice Address - Fax:828-287-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0815398Medicaid
NC7703094OtherMEDICAID DME
NC0815398Medicaid