MEDICINE MART LTC, LLC (NPI# 1174639041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174639041 |
| Entity Type | Organization |
| Organization Name | MEDICINE MART LTC, LLC |
| Practice Address |
214 S Main St Tabor City NC 28463-1904 |
| Mailing Address |
Po Box 550 Tabor City NC 28463-0550 |
| Practice Telephone | 9106536804 |
| Practice Fax Number | 9106534915 |
| Mailing Telephone | 9106536804 |
| Mailing Fax Number | 9106534915 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-07-30 |
| Authorized Official Name | STERLING G KOONCE (MANAGING AGENT) |
| Authorized Official Telephone | 9106536805 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
08435 | NC | Suppliers |
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
084535 | NC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 0245845 | 05 |
| Street Address |
214 S MAIN ST |
| City | TABOR CITY |
| State | NC |
| Zip Code | 28463-1904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992347157 | Mh Medical Services, PC | Nurse Practitioner | 1107 East 5th St., Tabor City, NC 28463 | 2019-10-09 |
| 1962658237 | Generations Family Medicine | Family Medicine | 106 Tabor Crossing, Tabor City, NC 28463 | 2008-08-18 |
| 1942404637 | Coming Together Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 5112 Chadbourn Hwy, Chadbourn, NC 28463 | 2007-06-14 |
| 1568509826 | Dameron Drug Store, Inc | Durable Medical Equipment & Medical Supplies | 100 S Main St., Tabor City, NC 28463 | 2007-01-30 |
| 1871560631 | Dameron Drug Store Inc | Durable Medical Equipment & Medical Supplies | 100 S Main St, Tabor City, NC 28463 | 2006-03-01 |
| 1497972996 | Edward Mcclendon IIi | Dentist | 501 Hickman Rd., Tabor City, NC 28463-0536 | 2007-04-19 |
| 1609105592 | Premier Behavioral Services Inc | Community/Behavioral Health | 104 Industrial Park Road, Tabor City, NC 28463-1665 | 2009-12-23 |
| 1467568337 | Twin States Vital Care, Inc. | Durable Medical Equipment & Medical Supplies | 218b S Main St, Tabor City, NC 28463-1904 | 2006-08-22 |
| 1912013889 | Tabor City Medicine Mart, Inc | Pharmacy | 220 S Main St, Tabor City, NC 28463-1904 | 2006-08-22 |
| 1053394775 | Twin State Home Healthcare Services Inc | Durable Medical Equipment & Medical Supplies | 218 S Main St, Tabor City, NC 28463-1904 | 2005-11-28 |
| Find all providers in zip 28463 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982236584 | Premier Pharmacy and Wellness Center LLC | Pharmacy | 3010 Monroe Rd Ste 101, Charlotte, NC 28205-7533 | 2020-02-11 |
| 1114564564 | Gaben | Pharmacy | 6602 Knightdale Blvd Ste 120, Knightdale, NC 27545-6567 | 2019-12-04 |
| 1316588346 | Nuevo Health, Inc | Pharmacy | 937 Old Knight Rd, Knightdale, NC 27545-9065 | 2019-10-01 |
| 1164987996 | Austin Drugs, Inc | Pharmacy | 3513 Suite B Highway 74 E, Monroe, NC 28110 | 2019-02-06 |
| 1326503657 | Village Pharmacy of Hampstead Inc | Pharmacy | 14057 Hwy 17, Suite 100, Hampstead, NC 28443 | 2019-01-31 |
| 1689148496 | Pharmscript of Nc LLC | Pharmacy | 140 Southcenter Ct Ste 600, Morrisville, NC 27560-8538 | 2019-01-15 |
| 1356812432 | Polaris Pharmacy Services of North Carolina, LLC | Pharmacy | 3300 Monroe Rd Unit E&f, Charlotte, NC 28205-7853 | 2018-12-16 |
| 1043799356 | Nelan LLC | Pharmacy | 3541 Randolph Rd Ste 104, Charlotte, NC 28211-1081 | 2018-08-08 |
| 1699280008 | The Script LLC | Pharmacy | 1450 Shaire Center Drive, Hudson, NC 28638 | 2017-12-07 |
| 1528592813 | Triad Choice Pharmacy | Pharmacy | 658 Waughtown St, Winston Salem, NC 27107-2217 | 2017-04-13 |
| Find all providers with the same taxonomy | ||||
| City | TABOR CITY |
| Zip Code | 28463 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.