Provider Demographics
NPI:1255490538
Name:BAGNALS PHARMACY
Entity Type:Organization
Organization Name:BAGNALS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAGNAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:843-358-3510
Mailing Address - Street 1:725 S. MAIN STREET
Mailing Address - Street 2:P.O. BOX 65
Mailing Address - City:AYNOR
Mailing Address - State:SC
Mailing Address - Zip Code:29511
Mailing Address - Country:US
Mailing Address - Phone:843-358-3510
Mailing Address - Fax:843-358-1703
Practice Address - Street 1:725 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511
Practice Address - Country:US
Practice Address - Phone:843-358-3510
Practice Address - Fax:843-358-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty