Provider Demographics
NPI:1346230216
Name:THE MEDICINE MART
Entity Type:Organization
Organization Name:THE MEDICINE MART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMART
Authorized Official - Middle Name:FINDLEY
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-859-4077
Mailing Address - Street 1:6129 CALHOUN MEMORIAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640
Mailing Address - Country:US
Mailing Address - Phone:864-859-4077
Mailing Address - Fax:864-859-6890
Practice Address - Street 1:6129 CALHOUN MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3781
Practice Address - Country:US
Practice Address - Phone:864-859-4077
Practice Address - Fax:864-859-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC039132544333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC734692Medicaid
NC1123940001Medicare ID - Type Unspecified