Provider Demographics
NPI:1053487967
Name:PIEDMONT PHARMACY ASSCOCIATES INC
Entity Type:Organization
Organization Name:PIEDMONT PHARMACY ASSCOCIATES INC
Other - Org Name:THE MEDICINE MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACISTOWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:V
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:803-286-8855
Mailing Address - Street 1:302 C NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720
Mailing Address - Country:US
Mailing Address - Phone:803-286-8855
Mailing Address - Fax:803-286-5079
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:C
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2132
Practice Address - Country:US
Practice Address - Phone:803-286-8855
Practice Address - Fax:803-286-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500072933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC772938Medicaid