Provider Demographics
NPI:1215007398
Name:PEE DEE FAMILY PHARMACY
Entity Type:Organization
Organization Name:PEE DEE FAMILY PHARMACY
Other - Org Name:PEE DEE HOME MED SUPPLY AND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:843-841-9003
Mailing Address - Street 1:608 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2502
Mailing Address - Country:US
Mailing Address - Phone:843-841-9003
Mailing Address - Fax:843-841-9736
Practice Address - Street 1:608 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2502
Practice Address - Country:US
Practice Address - Phone:843-841-9003
Practice Address - Fax:843-841-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC103773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC759794Medicaid
4223789OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3948830001Medicare NSC