Tabor City Medicine Mart, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

TABOR CITY MEDICINE MART, INC

Doing business as

Tabor City Medicine Mart

Practice address

220 S Main St
Tabor City, NC 28463-1904

Phone

(910) 653-4800

Fax

(910) 653-4915

NPI assigned

Aug 22, 2006

Last updated

Jul 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sterling G Koonce, RPHNPI 1841882552

Title

Owner/President

Phone

(910) 653-6805

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• TABOR CITY MEDICINE MART Doing business as

Medicare fee-for-service enrollment

Enrolled in NC4 enrollments

Enrollment records 4

Tax ID family

Tabor City Medicine Mart2 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.

• Tabor City Medicine Mart, Inc

  • Long Term Care Pharmacy
  • Tabor City, NC
  • NPI 1801513189
  NPD tax ID

Locations

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.

• Sterling Grady Koonce, RPH

  • Pharmacist
  • Tabor City, NC
  • NPI 1841882552
  Authorized official Same address or phone

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1912013889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284630580",
            "telephone_number": "910-653-4800",
            "fax_number": "910-653-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S MAIN ST",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284631904",
            "telephone_number": "910-653-4800",
            "fax_number": "910-653-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABOR CITY MEDICINE MART, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "KOONCE",
        "authorized_official_first_name": "STERLING",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "910-653-6805",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0245696",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TABOR CITY MEDICINE MART",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Renee Sykes, PHARMD
• Tabor City Emergency Services Inc.
• Tabor City Family Medical Clinic, PC
• Tabor City Family Medicine Center, Inc.
• Tabor City Medicine Mart, Inc
• The Asbury Homes, Inc.
• Gayle Marie Thompson, D.C.
• William Hal Thompson, D.C.
• Tara Strickland Todd
• Twin State Home Healthcare Services Inc (Medicine Mart Home Healthcare svs. Inc)

• Community/Retail Pharmacy in Tabor City, NC
• Providers in Tabor City, 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 Jul 29, 2020; 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.