Provider Demographics
NPI:1093864654
Name:EUREKA DRUG STORES, INC.
Entity Type:Organization
Organization Name:EUREKA DRUG STORES, INC.
Other - Org Name:VALUE-PAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-984-3541
Mailing Address - Street 1:1032 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4308
Mailing Address - Country:US
Mailing Address - Phone:803-432-5851
Mailing Address - Fax:803-432-7861
Practice Address - Street 1:1032 BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4308
Practice Address - Country:US
Practice Address - Phone:803-432-5851
Practice Address - Fax:803-432-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC718442Medicaid