Provider Demographics
NPI:1447398375
Name:HARTSVILLE DRUG CO INC
Entity Type:Organization
Organization Name:HARTSVILLE DRUG CO INC
Other - Org Name:HARTSVILLE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEB
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-332-6581
Mailing Address - Street 1:134 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4216
Mailing Address - Country:US
Mailing Address - Phone:843-332-6581
Mailing Address - Fax:
Practice Address - Street 1:134 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4216
Practice Address - Country:US
Practice Address - Phone:843-332-6581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC113153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128938OtherPK
SC700744Medicaid