Provider Demographics
NPI:1992896419
Name:AYERS DRUGSTORE INC
Entity type:Organization
Organization Name:AYERS DRUGSTORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-754-6453
Mailing Address - Street 1:202-A HARPER AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5196
Mailing Address - Country:US
Mailing Address - Phone:828-754-6453
Mailing Address - Fax:828-754-5031
Practice Address - Street 1:202-A HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5196
Practice Address - Country:US
Practice Address - Phone:828-754-6453
Practice Address - Fax:828-754-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04759333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702000OtherMEDICAID DME
3408211OtherNABP NUMBER
NC0145383Medicaid
3408211OtherNABP NUMBER