Provider Demographics
NPI:1245591668
Name:SHERTECH PHARMACY SPARTANBURG
Entity Type:Organization
Organization Name:SHERTECH PHARMACY SPARTANBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:864-585-3850
Mailing Address - Street 1:1360 DRAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-5104
Mailing Address - Country:US
Mailing Address - Phone:864-585-3850
Mailing Address - Fax:864-585-3760
Practice Address - Street 1:1360 DRAYTON RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-5104
Practice Address - Country:US
Practice Address - Phone:864-585-3850
Practice Address - Fax:864-585-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33403336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4220644OtherNABP