| Organization Name: | KMART PHARMACY |
| NPI Number: | 1265784813 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AXEL MARTELL (REGISTERED PHARMACIST) |
| Mailing Address: | 2455 Lewisville Clemmons Rd Clemmons |
| State: | NC US |
| Postal Code: | 270128709 |
| Phone Number: | 3367665424 |
| Fax Number: | 3357663100 |
| NPI Enumeration Date: | 10/07/2012 |
| NPI Last Update Date: | 10/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1800X |
| License Number: | 15802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Corporate Health |
| Taxonomy Definition: | |