Provider Demographics
NPI:1033223011
Name:OKATIE PHARMACY INC
Entity Type:Organization
Organization Name:OKATIE PHARMACY INC
Other - Org Name:OKATIE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAVO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-705-4444
Mailing Address - Street 1:30 WILLIAM POPE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7515
Mailing Address - Country:US
Mailing Address - Phone:843-705-4444
Mailing Address - Fax:843-705-4445
Practice Address - Street 1:30 WILLIAM POPE DR
Practice Address - Street 2:STE 103
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7515
Practice Address - Country:US
Practice Address - Phone:843-705-4444
Practice Address - Fax:843-705-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC500053513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4223246OtherNCPDP PROVIDER IDENTIFICATION NUMBER
SC753514Medicaid
4470980001Medicare NSC