Provider Demographics
NPI:1346760592
Name:HARLEYVILLE DRUG LLC
Entity Type:Organization
Organization Name:HARLEYVILLE DRUG LLC
Other - Org Name:HARLEYVILLE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-563-1010
Mailing Address - Street 1:701 N PARLER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2233
Mailing Address - Country:US
Mailing Address - Phone:843-563-9384
Mailing Address - Fax:843-563-9386
Practice Address - Street 1:108 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29448-3700
Practice Address - Country:US
Practice Address - Phone:843-462-7646
Practice Address - Fax:843-462-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
SC172973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171907OtherPK
SC717297Medicaid