NPIMap

Organization Active NPI

Realo Discount Drug Stores of Eastern North Carolina, Inc.

  • Community/Retail Pharmacy
  • Jacksonville, NC
National Provider Identifier
1720007610
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
08117 Issued in NC
Legal business name
REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC.
Practice address
2680 Henderson Dr
Unit 1
Jacksonville, NC 28546-5296
Phone
(910) 455-9982
Fax
(910) 455-9588
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

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

Authorized official

Name
Mr. Robert Joseph McLaughlin Jr., RPH
Title
President
Phone
(252) 639-9006

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 4913000002 NC
Oxygen Equipment & Supplies (DME) 332BX2000X 4913000002 NC
Community/Retail Pharmacy 3336C0003X 08117 NC Primary

Addresses

Primary practice location

2680 Henderson Dr
Unit 1
Jacksonville, NC 28546-5296

Mailing address

1301 Commerce Dr
New Bern, NC 28562-2213
Phone (252) 639-9006

Other identifiers 3

IdentifierTypeStateIssuer
3440029OtherNCNCPDP NUMBER
08117OtherNCNCBOP
675628MedicaidNC

Other names 1

  • Realo Discount Drugs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051104000328 NC Part B Supplier - Mass Immunization (Roster Biller Only) 7618995986 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Bern, NC; Wilson, NC; Wallace, NC; Hampstead, NC; Greenville, NC; Beaufort, NC; Fuquay Varina, NC; Clayton, NC…
O20100930036817 NC DME Supplier - Pharmacy 7618995986 Practice locations: Jacksonville, NC

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2093895Realo Discount Drug Stores of Eastern NC, Inc2680 Henderson Drive Unit 1, Jacksonville, NC 28546Certificate of waiverApr 6, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Realo Discount Drug Stores of Easte2680 Henderson Dr, Jacksonville, NC 28546-5297(910) 455-9982 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jul 10, 2003

National Provider Directory

National Provider Directory
Tax ID family
Realo Discount Drug Stores15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

2680 Henderson Dr
Jacksonville, NC 28546

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452470400000",
    "number": "1720007610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 COMMERCE DR",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285622213",
            "telephone_number": "252-639-9006",
            "fax_number": "252-638-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 HENDERSON DR",
            "address_2": "UNIT 1",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465296",
            "telephone_number": "910-455-9982",
            "fax_number": "910-455-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REALO DISCOUNT DRUG STORES OF EASTERN NORTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2016-01-11",
        "status": "A",
        "authorized_official_last_name": "MCLAUGHLIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-639-9006",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "4913000002",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NC",
            "license": "4913000002",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "08117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3440029",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBOP",
            "identifier": "08117",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "675628",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Realo Discount Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.