1346432192 NPI number — TOWN AND COUNTRY PHARMACY

Table of content: (NPI 1346432192)

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".




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