Provider Demographics
NPI:1003004995
Name:PIGGLY WIGGLY ANDREWS, INC.
Entity Type:Organization
Organization Name:PIGGLY WIGGLY ANDREWS, INC.
Other - Org Name:PIGGLY WIGGLY PHARMACY #16
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-9880
Mailing Address - Street 1:PO BOX 118047
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8047
Mailing Address - Country:US
Mailing Address - Phone:843-554-9880
Mailing Address - Fax:843-202-8211
Practice Address - Street 1:15 WEST ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-2543
Practice Address - Country:US
Practice Address - Phone:843-264-3291
Practice Address - Fax:843-264-5425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIGGLY WIGGLY ANDREWS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5001882332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC718828Medicaid
SC4379350001Medicare NSC