Provider Demographics
NPI:1154330926
Name:LAUREL PHARMACY INC.
Entity Type:Organization
Organization Name:LAUREL PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-227-4464
Mailing Address - Street 1:2761 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2021
Mailing Address - Country:US
Mailing Address - Phone:803-254-2761
Mailing Address - Fax:803-779-2515
Practice Address - Street 1:2761 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2021
Practice Address - Country:US
Practice Address - Phone:803-254-2761
Practice Address - Fax:803-779-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-0058473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0165260001Medicare NSC