Provider Demographics
NPI:1235289562
Name:MEDICAL ARTS PHARMACY OF HARTSVILLE
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY OF HARTSVILLE
Other - Org Name:NURSING HOME DISPENSARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRE AND TRES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-332-7529
Mailing Address - Street 1:212 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4520
Mailing Address - Country:US
Mailing Address - Phone:843-332-7529
Mailing Address - Fax:843-332-2589
Practice Address - Street 1:212 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4520
Practice Address - Country:US
Practice Address - Phone:843-332-7529
Practice Address - Fax:843-332-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC20443336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC702116Medicaid
2089701OtherPK