Provider Demographics
NPI:1164426938
Name:BLOCKER & TIMMERMAN DRUG CO.,INC.
Entity Type:Organization
Organization Name:BLOCKER & TIMMERMAN DRUG CO.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-637-6155
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-1326
Mailing Address - Country:US
Mailing Address - Phone:803-637-6155
Mailing Address - Fax:803-637-3753
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-1326
Practice Address - Country:US
Practice Address - Phone:803-637-6155
Practice Address - Fax:803-637-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-000987332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0999790001Medicare ID - Type Unspecified