Provider Demographics
NPI:1568509826
Name:DAMERON DRUG STORE, INC
Entity type:Organization
Organization Name:DAMERON DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-653-3089
Mailing Address - Street 1:100 S MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463
Mailing Address - Country:US
Mailing Address - Phone:910-653-3089
Mailing Address - Fax:910-653-5839
Practice Address - Street 1:100 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463
Practice Address - Country:US
Practice Address - Phone:910-653-3089
Practice Address - Fax:910-653-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies