Provider Demographics
NPI:1447529631
Name:CLINTON DRUG COMPANY
Entity type:Organization
Organization Name:CLINTON DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-592-8444
Mailing Address - Street 1:307 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2907
Mailing Address - Country:US
Mailing Address - Phone:910-592-8444
Mailing Address - Fax:910-592-6505
Practice Address - Street 1:307 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2907
Practice Address - Country:US
Practice Address - Phone:910-592-8444
Practice Address - Fax:910-592-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC055333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0825281Medicaid
NC05533OtherNC BOARD OF PHARMACY REGISTRATION
NCQ36805AOtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER