Provider Demographics
NPI:1366456634
Name:SOCIETY HILL PHARMACY
Entity Type:Organization
Organization Name:SOCIETY HILL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-378-0200
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:SOCIETY HILL PHARMACY
Mailing Address - City:SOCIETY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29593
Mailing Address - Country:US
Mailing Address - Phone:843-378-0200
Mailing Address - Fax:843-378-0202
Practice Address - Street 1:743 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOCIETY HILL
Practice Address - State:SC
Practice Address - Zip Code:29593
Practice Address - Country:US
Practice Address - Phone:843-378-0200
Practice Address - Fax:843-378-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001651332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC716512Medicaid
SC716512Medicaid