Provider Demographics
NPI:1194397216
Name:CONGRESS STREET PHARMACY
Entity Type:Organization
Organization Name:CONGRESS STREET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-984-1560
Mailing Address - Street 1:12 CONGRESS ST N STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1529
Mailing Address - Country:US
Mailing Address - Phone:803-818-4116
Mailing Address - Fax:
Practice Address - Street 1:12 CONGRESS ST N STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1529
Practice Address - Country:US
Practice Address - Phone:803-818-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy