Provider Demographics
NPI:1134102460
Name:MCLESKEY TODD PHARMACY OF TRAVELERS REST INC
Entity Type:Organization
Organization Name:MCLESKEY TODD PHARMACY OF TRAVELERS REST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:STACK
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-834-4678
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-0487
Mailing Address - Country:US
Mailing Address - Phone:864-834-4678
Mailing Address - Fax:864-834-4614
Practice Address - Street 1:32 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690
Practice Address - Country:US
Practice Address - Phone:864-834-4678
Practice Address - Fax:834-834-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500030943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC730945Medicaid
4212394OtherNABP NUMBER
SC730945Medicaid