Provider Demographics
NPI:1093141970
Name:CLINTON DISCOUNT PHARMACY LLC
Entity Type:Organization
Organization Name:CLINTON DISCOUNT PHARMACY LLC
Other - Org Name:CLINTON DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-387-7151
Mailing Address - Street 1:202 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2304
Mailing Address - Country:US
Mailing Address - Phone:864-387-7151
Mailing Address - Fax:864-342-7938
Practice Address - Street 1:202 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2304
Practice Address - Country:US
Practice Address - Phone:864-387-7151
Practice Address - Fax:864-342-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC148333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142243OtherPK