Provider Demographics
NPI:1467000588
Name:OCONEE NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:OCONEE NEIGHBORHOOD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAN KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-886-1096
Mailing Address - Street 1:12019 N RADIO STATION RD STE G
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1143
Mailing Address - Country:US
Mailing Address - Phone:864-886-1096
Mailing Address - Fax:864-973-9100
Practice Address - Street 1:12019 N RADIO STATION RD STE G
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1143
Practice Address - Country:US
Practice Address - Phone:864-886-1096
Practice Address - Fax:864-973-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy