Provider Demographics
NPI:1346571460
Name:PALMETTO FAMILY PHARMACY
Entity Type:Organization
Organization Name:PALMETTO FAMILY PHARMACY
Other - Org Name:PALMETTO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-981-4957
Mailing Address - Street 1:1030 OAKLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3035
Mailing Address - Country:US
Mailing Address - Phone:803-980-7272
Mailing Address - Fax:803-980-6969
Practice Address - Street 1:1030 OAKLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3074
Practice Address - Country:US
Practice Address - Phone:803-980-7272
Practice Address - Fax:803-980-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123656OtherPK
SC710788Medicaid