Provider Demographics
NPI:1225600448
Name:THE P BUILDING PHARMACY AT THE VEIL
Entity Type:Organization
Organization Name:THE P BUILDING PHARMACY AT THE VEIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NOVELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-245-8330
Mailing Address - Street 1:3450 MAIN HWY
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1865
Mailing Address - Country:US
Mailing Address - Phone:803-245-8330
Mailing Address - Fax:880-324-5839
Practice Address - Street 1:3450 MAIN HWY
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1865
Practice Address - Country:US
Practice Address - Phone:803-245-8330
Practice Address - Fax:032-458-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOOOOOOOOOOMedicaid