Provider Demographics
NPI:1073847463
Name:PIGGLY WIGGLY RETAIL STORES, INC.
Entity Type:Organization
Organization Name:PIGGLY WIGGLY RETAIL STORES, INC.
Other - Org Name:PIGGLY WIGGLY PHARMACY #54
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-9880
Mailing Address - Street 1:PO BOX 118047
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423
Mailing Address - Country:US
Mailing Address - Phone:843-554-9880
Mailing Address - Fax:843-202-8211
Practice Address - Street 1:4430 HWY. 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELL'S INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-651-5164
Practice Address - Fax:843-651-5237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIGGLY WIGGLY CAROLINA CO. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-01
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83193336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC783191Medicaid
SC783191Medicaid