Provider Demographics
NPI:1528388279
Name:NYES PHARMACY OF CONWAY INC
Entity Type:Organization
Organization Name:NYES PHARMACY OF CONWAY INC
Other - Org Name:NYE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-248-5015
Mailing Address - Street 1:1600 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4112
Mailing Address - Country:US
Mailing Address - Phone:843-248-5015
Mailing Address - Fax:843-488-1942
Practice Address - Street 1:1600 10TH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4112
Practice Address - Country:US
Practice Address - Phone:843-248-5015
Practice Address - Fax:843-488-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC109573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4229692OtherNCPDP PROVIDER IDENTIFICATION NUMBER