Provider Demographics
NPI:1477679843
Name:MEDI FARE DRUG AND HOME HEALTH CENTER INC
Entity Type:Organization
Organization Name:MEDI FARE DRUG AND HOME HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:864-839-6384
Mailing Address - Street 1:300 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1548
Mailing Address - Country:US
Mailing Address - Phone:864-839-6384
Mailing Address - Fax:864-839-3513
Practice Address - Street 1:300 W PINE ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-1548
Practice Address - Country:US
Practice Address - Phone:864-839-6384
Practice Address - Fax:864-839-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500080843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC50008084OtherPHARMACY PERMIT
SC780847Medicaid