Provider Demographics
NPI:1285754564
Name:ONEALS DRUG STORE INC
Entity type:Organization
Organization Name:ONEALS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:252-943-2643
Mailing Address - Street 1:292 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1414
Mailing Address - Country:US
Mailing Address - Phone:252-943-2643
Mailing Address - Fax:
Practice Address - Street 1:292 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1414
Practice Address - Country:US
Practice Address - Phone:252-943-2643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000054332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700129Medicaid
NC7700129Medicaid