Provider Demographics
NPI:1376876029
Name:ROCK HILL PHARMACY
Entity Type:Organization
Organization Name:ROCK HILL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:APELU
Authorized Official - Last Name:FETUAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-324-1875
Mailing Address - Street 1:1420 EBENEZER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2743
Mailing Address - Country:US
Mailing Address - Phone:803-324-1875
Mailing Address - Fax:803-329-7795
Practice Address - Street 1:1420 EBENEZER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2743
Practice Address - Country:US
Practice Address - Phone:803-324-1875
Practice Address - Fax:803-329-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy