1336298983 NPI number — EUREKA DRUG STORES, INC

Table of content: (NPI 1336298983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336298983 NPI number — EUREKA DRUG STORES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUREKA DRUG STORES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCOTTIE DISCOUNT DRUGS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336298983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNETTSVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29512-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-479-7251
Provider Business Mailing Address Fax Number:
843-479-3052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNETTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29512-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-479-7251
Provider Business Practice Location Address Fax Number:
843-479-3052
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
864-984-3541

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0717 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 707175 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".