Provider Demographics
NPI:1033207493
Name:PHARMACY EXPRESS DRUG STORE INC
Entity Type:Organization
Organization Name:PHARMACY EXPRESS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-665-9199
Mailing Address - Street 1:209C SOUTH GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-665-9199
Mailing Address - Fax:843-667-0585
Practice Address - Street 1:209C SOUTH GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-665-9199
Practice Address - Fax:843-667-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SC500009686333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1033207493OtherNPI
4225098OtherOTHER ID NUMBER
SC796865Medicaid
SC1033207493OtherNPI