NPIMap

Organization Active NPI

Innes Street Drug Co. Inc. #3

  • Community/Retail Pharmacy
  • Salisbury, NC
National Provider Identifier
1568731594
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
05609 Issued in NC
Legal business name
INNES STREET DRUG CO. INC. #3
Practice address
1706 W Innes St
Salisbury, NC 28144-2552
Phone
(704) 636-1712
Fax
(704) 637-0324
NPI assigned
Dec 20, 2011
Organization subpart
Yes
Parent organization
INNES STREET DRUG CO.,INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Mr. Stephen Weldon Fuller
Title
Vice-President/ Pharmacist-Manager
Phone
(704) 636-1712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 05609 NC Primary

Addresses

Primary practice location

1706 W Innes St
Salisbury, NC 28144-2552

Mailing address

1706 W Innes St
Salisbury, NC 28144-2552
Phone (704) 636-1712

Other identifiers 2

IdentifierTypeStateIssuer
0805473MedicaidNC
Q371140001OtherNCMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Innes St Drug Co Inc2 organizations share this tax ID, including this one
Part of
Innes St Drug Co Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1706 W Innes St
Salisbury, NC 28144
Phone (704) 630-1155

NPI Registry JSON

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1568731594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 W INNES ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281442552",
            "telephone_number": "704-636-1712",
            "fax_number": "704-637-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 W INNES ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281442552",
            "telephone_number": "704-636-1712",
            "fax_number": "704-637-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNES STREET DRUG CO. INC. #3",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNES STREET DRUG CO.,INC",
        "enumeration_date": "2011-12-20",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "WELDON",
        "authorized_official_title_or_position": "VICE-PRESIDENT/ PHARMACIST-MANAGER",
        "authorized_official_telephone_number": "704-636-1712",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "05609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805473",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Q371140001",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.