Provider Demographics
NPI:1497863062
Name:COMMUNITY PHARMACY OF FORT MILL INC.
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY OF FORT MILL INC.
Other - Org Name:FORT MILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-548-2851
Mailing Address - Street 1:601 SPRINGCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7314
Mailing Address - Country:US
Mailing Address - Phone:803-548-2851
Mailing Address - Fax:803-548-2717
Practice Address - Street 1:601 SPRINGCREST DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7314
Practice Address - Country:US
Practice Address - Phone:803-548-2851
Practice Address - Fax:803-548-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13249333600000X
NC132493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130188OtherPK
SC713249Medicaid