Provider Demographics
NPI:1437283058
Name:SANDHILLS PHARMACY, INC.
Entity Type:Organization
Organization Name:SANDHILLS PHARMACY, INC.
Other - Org Name:SANDHILLS HEALTH CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEFEE
Authorized Official - Suffix:
Authorized Official - Credentials:CDE
Authorized Official - Phone:843-335-8297
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-0900
Mailing Address - Country:US
Mailing Address - Phone:843-335-8297
Mailing Address - Fax:843-335-8555
Practice Address - Street 1:645 S SEVENTH STREET
Practice Address - Street 2:
Practice Address - City:MCBEE
Practice Address - State:SC
Practice Address - Zip Code:29101
Practice Address - Country:US
Practice Address - Phone:843-335-8297
Practice Address - Fax:843-335-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50002450333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE036Medicaid
SC1437283058Medicare NSC
SCQ325480001Medicare ID - Type Unspecified
SCQ325480002Medicare PIN