Eden Drug Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

09458 Issued in NC

Legal business name

EDEN DRUG INC

Doing business as

Eden Drug Health Mart

Practice address

103 W Stadium Dr
Eden, NC 27288-3329

Phone

(336) 627-4854

Fax

(336) 627-8925

NPI assigned

Jan 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert L Crouch, R.PH, CPPNPI 1780858126

Title

President, Pharmacist

Phone

(336) 627-4854

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Eden Drug Health Mart Doing business as

Medicare fee-for-service enrollment

Enrolled in NC3 enrollments

Enrollment records 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert L Crouch, RPH, CPP, CFTS

  • Orthotic Fitter
  • Eden, NC
  • NPI 1780858126
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1215089222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W STADIUM DR",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272883329",
            "telephone_number": "336-627-4854",
            "fax_number": "336-627-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W STADIUM DR",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272883329",
            "telephone_number": "336-627-4854",
            "fax_number": "336-627-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "CROUCH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT, PHARMACIST",
        "authorized_official_telephone_number": "336-627-4854",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH, CPP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "09458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9110968",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7700318",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "03748",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "43812",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Drug Health Mart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eckerd Corporation (Rite Aid Pharmacy 11339)
• Eden Chiropractic
• Eden Drug, Inc.
• Eden Drug, Inc. (Eden Drug Health Mart)
• Eden Health & Wellness Center
• Eden Internal Medicine PLLC
• Eden Internal Medicine PLLC

• Durable Medical Equipment & Medical Supplies in Eden, NC
• Providers in Eden, NC by specialty
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.