Basic Information
| Provider Information | |||||||||
| NPI: | 1003827247 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INGLES MARKETS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | INGLES PHARMACY #110 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 603941 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282603941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286692941 | ||||||||
| FaxNumber: | 8286693685 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 HWY 64 E | ||||||||
| Address2: | |||||||||
| City: | CASHIERS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287436312 | ||||||||
| FaxNumber: | 8287436213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CUCCHI | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF PHARMACY | ||||||||
| AuthorizedOfficialTelephone: | 8286692941 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INGLES MARKETS INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RPH | ||||||||
| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 07733 | NC | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 3438668 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 0505164 | 05 | NC | MEDICAID |