1346432192 NPI number — TOWN AND COUNTRY PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346432192 NPI number — TOWN AND COUNTRY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN AND COUNTRY PHARMACY
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:
Provider Other Organization Name Type Code:
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:
1346432192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ELLENTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29809-0442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-652-3006
Provider Business Mailing Address Fax Number:
803-652-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 MAIN ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ELLENTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29809-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-652-3006
Provider Business Practice Location Address Fax Number:
803-652-3036
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALTIWANGER
Authorized Official First Name:
ADRIANA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
803-644-6721

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 010100 , 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: DE3078 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com