Provider Demographics
NPI:1033270830
Name:CAROLINA DRUG STORE INCORPORATED
Entity Type:Organization
Organization Name:CAROLINA DRUG STORE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-2865
Mailing Address - Street 1:52 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3216
Mailing Address - Country:US
Mailing Address - Phone:843-393-2865
Mailing Address - Fax:843-393-4445
Practice Address - Street 1:52 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3216
Practice Address - Country:US
Practice Address - Phone:843-393-2865
Practice Address - Fax:843-393-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50002882333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC728827Medicaid