Provider Demographics
NPI:1215045406
Name:THE PHARMACY AT PARK PLACE
Entity Type:Organization
Organization Name:THE PHARMACY AT PARK PLACE
Other - Org Name:PARK PLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEOPARD
Authorized Official - Suffix:
Authorized Official - Credentials:RHP
Authorized Official - Phone:864-985-1299
Mailing Address - Street 1:12019 N RADIO STATION RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:864-985-1299
Mailing Address - Fax:864-985-1277
Practice Address - Street 1:12019 N RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-985-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHARMACY AT PARK PLACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC037126913333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5496200001Medicare NSC