Provider Demographics
NPI:1326368010
Name:LIFE PHARMACY OF GREER LLC
Entity Type:Organization
Organization Name:LIFE PHARMACY OF GREER LLC
Other - Org Name:SKRIP SHOPPE COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-755-9600
Mailing Address - Street 1:406 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1550
Mailing Address - Country:US
Mailing Address - Phone:864-879-2325
Mailing Address - Fax:864-849-0961
Practice Address - Street 1:406 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1550
Practice Address - Country:US
Practice Address - Phone:864-879-2325
Practice Address - Fax:864-849-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC162583336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154671OtherPK
SCDC08797-3OtherDHEC