Provider Demographics
NPI:1912986001
Name:W C ROSE DRUG STORE INC
Entity type:Organization
Organization Name:W C ROSE DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-237-1188
Mailing Address - Street 1:309-B NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-1188
Mailing Address - Fax:252-206-1990
Practice Address - Street 1:309-B NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-1188
Practice Address - Fax:252-206-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04464333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401697OtherOTHER
NC0985317Medicaid
NC0399COtherBCBS
2340306Medicare PIN