Provider Demographics
NPI:1477619708
Name:PIGGLY WIGGLY FOLLY ROAD INC
Entity Type:Organization
Organization Name:PIGGLY WIGGLY FOLLY ROAD INC
Other - Org Name:PIGGLY WIGGLY PHARMACY #17
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-9880
Mailing Address - Street 1:PO BOX 118047
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8047
Mailing Address - Country:US
Mailing Address - Phone:843-554-9880
Mailing Address - Fax:843-202-8211
Practice Address - Street 1:1985 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-9577
Practice Address - Country:US
Practice Address - Phone:843-762-6591
Practice Address - Fax:843-762-9377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIGGLY WIGGLY CAROLINA CO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50008111332B00000X
SC50008113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4404910004Medicare NSC