Provider Demographics
NPI:1528376720
Name:808 PHARMACY AND SUPPLY COMPANY
Entity Type:Organization
Organization Name:808 PHARMACY AND SUPPLY COMPANY
Other - Org Name:CORDELIA M HARDIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORDELIA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-415-2671
Mailing Address - Street 1:1030 EDWARDS
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730
Mailing Address - Country:US
Mailing Address - Phone:803-415-2671
Mailing Address - Fax:803-415-2671
Practice Address - Street 1:1030 EDWARDS ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2549
Practice Address - Country:US
Practice Address - Phone:803-415-2671
Practice Address - Fax:803-415-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy