Davis Drug Company of Kenly, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

11512 Issued in NC

Legal business name

DAVIS DRUG COMPANY OF KENLY, INC.

Practice address

103 W 2ND St.
Kenly, NC 27542-0235

Phone

(919) 284-2010

Fax

(919) 284-2231

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brock Elliot Wiley, PHARM DNPI 1790060929

Title

President/Pharmacist Manager

Phone

(919) 284-2010

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Davis Drug Company Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Davis Drug Company of Kenly, Inc.

  • Community/Retail Pharmacy
  • Benson, NC
  • NPI 1407372048

  3375715527

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Davis Drug Company2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Davis Drug Company of Kenly, Inc.

  • Community/Retail Pharmacy
  • Benson, NC
  • NPI 1407372048
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock Elliot Wiley, PHARM.D

  • Pharmacist
  • Kenly, NC
  • NPI 1790060929
  NPD Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1578640652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 235",
            "address_2": "103 W 2ND ST.",
            "city": "KENLY",
            "state": "NC",
            "postal_code": "275420235",
            "telephone_number": "919-284-2010",
            "fax_number": "919-284-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W 2ND ST.",
            "city": "KENLY",
            "state": "NC",
            "postal_code": "275420235",
            "telephone_number": "919-284-2010",
            "fax_number": "919-284-2231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS DRUG COMPANY OF KENLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "ELLIOT",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST MANAGER",
        "authorized_official_telephone_number": "919-284-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515679",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Drug Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amelia Burns
• Amanda Cannon
• Donna Michelle Capps, M.D.
• Kayla Cavenaugh
• Changing Grace Home Care, LLC
• Jerry Carl Davis, RPH
• Lynn L Davis
• Robin Ray Davis, RPH
• Eclipse Home Healthcare
• Catherine Bridgers Edwards, OTR/L

• Community/Retail Pharmacy in Kenly, NC
• Providers in Kenly, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.