Provider Demographics
NPI:1003480013
Name:PALMETTO PATRIOTS HOME PHARMACY
Entity Type:Organization
Organization Name:PALMETTO PATRIOTS HOME PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:864-915-1816
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29623-5285
Mailing Address - Country:US
Mailing Address - Phone:864-480-7163
Mailing Address - Fax:
Practice Address - Street 1:120 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2267
Practice Address - Country:US
Practice Address - Phone:864-480-7163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VSI OF SOUTH CAROLINA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-14
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy