Provider Demographics
NPI:1073561890
Name:PHARMACY EXPRESS LLC
Entity Type:Organization
Organization Name:PHARMACY EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-617-3235
Mailing Address - Street 1:1937 W PALMETTO ST
Mailing Address - Street 2:PMB 122
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3916
Mailing Address - Country:US
Mailing Address - Phone:843-665-2066
Mailing Address - Fax:843-665-5128
Practice Address - Street 1:2803 W. PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3916
Practice Address - Country:US
Practice Address - Phone:843-665-2066
Practice Address - Fax:843-665-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2454Medicaid
SCEN2144Medicaid
SCEN2144Medicaid