Provider Demographics
NPI:1356472526
Name:ORANGEBURG PHARMACY, INC.
Entity Type:Organization
Organization Name:ORANGEBURG PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAMLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:803-534-2226
Mailing Address - Street 1:1425 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6070
Mailing Address - Country:US
Mailing Address - Phone:803-534-2226
Mailing Address - Fax:803-531-2837
Practice Address - Street 1:1425 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6070
Practice Address - Country:US
Practice Address - Phone:803-534-2226
Practice Address - Fax:803-531-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001812332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC603617Medicaid
SC0524630001Medicare NSC