Provider Demographics
NPI:1871977827
Name:REALO DISCOUNT DRUG OF ONSLOW
Entity type:Organization
Organization Name:REALO DISCOUNT DRUG OF ONSLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-514-0461
Mailing Address - Street 1:423 YOPP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 YOPP RD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3594
Practice Address - Country:US
Practice Address - Phone:910-347-9684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REALO DISCOUNT DRUG OF EASTERN NORTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25138333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy