1588917553 NPI number — LOWRY DRUG CO

Table of content: (NPI 1588917553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588917553 NPI number — LOWRY DRUG CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWRY DRUG CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588917553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 HARTNESS RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28677-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-872-5226
Provider Business Mailing Address Fax Number:
704-873-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 HARTNESS RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28677-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-872-5226
Provider Business Practice Location Address Fax Number:
704-873-4050
Provider Enumeration Date:
10/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOWRY
Authorized Official First Name:
FRED
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
RPH/PRESIDENT
Authorized Official Telephone Number:
704-873-2256

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  09240 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09240 . This is a "NC PHARMACY LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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