Provider Information for 1609942366
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
MAST DRUG CO INC
Other Names:Doing Business As:MAST PHARMACYOrganization Subpart: NO
NPI: 1609942366
Last Updated: 2022-08-26
Certification Date: 2022-08-16
Certification Date: 2022-08-16
Details
Name | Value | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
NPI | 1609942366 | ||||||||||||||||
Enumeration Date | 2006-11-27 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
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 |
| ||||||||||||||||
Other Identifiers |
| ||||||||||||||||
Taxonomy |
|