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Provider Information for 1609942366


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MAST DRUG CO INC

Other Names:  
Doing Business As: 
MAST PHARMACY

Organization Subpart: NO

NPI: 1609942366
Last Updated: 2022-08-26
Certification Date: 2022-08-16

Details

NameValue
NPI1609942366
Enumeration Date2006-11-27
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: RICHARD I FLYE Jr.
Title: PRESIDENT
Phone: 2524383112
Mailing Address 805 S GARNETT ST
HENDERSON, NC 27536
United States

Phone: 252-438-3112 | Fax:252-492-4096
 
Primary Practice Address 307 WEST BLVD
WILLIAMSTON, NC 27892-2145
United States

Phone: 252-792-1015 | Fax:252-792-2174
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNC0585091
Other (non-Medicare)2068431PK
MEDICAIDNC7700506
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 3336C0004X - Pharmacy - Compounding Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyNC03766