Provider Demographics
NPI:1154859494
Name:MCP OF SUMTER, INC.
Entity Type:Organization
Organization Name:MCP OF SUMTER, INC.
Other - Org Name:MEDICAL COURT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERMIT HOLLIDAY
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ELVIN
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:803-420-6308
Mailing Address - Street 1:776 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4771
Mailing Address - Country:US
Mailing Address - Phone:803-773-5605
Mailing Address - Fax:803-773-5605
Practice Address - Street 1:776 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4771
Practice Address - Country:US
Practice Address - Phone:803-773-5605
Practice Address - Fax:803-773-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC170963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy