1619256724 NPI number — NEW VISION PHARMACY OF SOUTH CAROLINA

Table of content: MS. JESICA AMAYA-FLORES LPN (NPI 1194113365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619256724 NPI number — NEW VISION PHARMACY OF SOUTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW VISION PHARMACY OF SOUTH CAROLINA
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:
NEW VISION PHARMACY
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:
1619256724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29641-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-517-0423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 N FRANKLIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29617-7600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-423-5565
Provider Business Practice Location Address Fax Number:
877-845-9091
Provider Enumeration Date:
08/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCURO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO/PHARMACIST
Authorized Official Telephone Number:
864-517-0423

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  12032 , 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)





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