Provider Demographics
NPI:1336288901
Name:M CORP
Entity Type:Organization
Organization Name:M CORP
Other - Org Name:MEDICINE MART PHARMACY OF LEXINGTON SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-957-5969
Mailing Address - Street 1:348B COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2657
Mailing Address - Country:US
Mailing Address - Phone:803-957-5969
Mailing Address - Fax:803-808-1829
Practice Address - Street 1:348B COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2657
Practice Address - Country:US
Practice Address - Phone:803-957-5969
Practice Address - Fax:803-808-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-008219332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME237Medicaid