Provider Demographics
NPI:1083801286
Name:IRMO DRUG INC
Entity Type:Organization
Organization Name:IRMO DRUG INC
Other - Org Name:IRMO DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-749-7485
Mailing Address - Street 1:1009 LAKE MURRAY BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2824
Mailing Address - Country:US
Mailing Address - Phone:803-749-7485
Mailing Address - Fax:803-749-7488
Practice Address - Street 1:1009 LAKE MURRAY BLVD
Practice Address - Street 2:STE B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2824
Practice Address - Country:US
Practice Address - Phone:803-749-7485
Practice Address - Fax:803-749-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
SC96433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093411OtherPK