Provider Demographics
NPI:1316249873
Name:TAYLOE DRUG COMPANY, INC.
Entity type:Organization
Organization Name:TAYLOE DRUG COMPANY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:CHAMPION
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CRC, CPHT
Authorized Official - Phone:252-946-2084
Mailing Address - Street 1:601 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3408
Mailing Address - Country:US
Mailing Address - Phone:252-946-2084
Mailing Address - Fax:252-946-9552
Practice Address - Street 1:601 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3408
Practice Address - Country:US
Practice Address - Phone:252-946-2084
Practice Address - Fax:252-946-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC018093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0075259Medicaid
NC7700839Medicaid
NC1396755401OtherNPI
NC0269580001Medicare NSC