Provider Demographics
NPI:1558309534
Name:BLYTHEWOOD PROFESSIONAL DRUG COMPANY
Entity Type:Organization
Organization Name:BLYTHEWOOD PROFESSIONAL DRUG COMPANY
Other - Org Name:BLYTHEWOOD PHARMACY AND HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:N
Authorized Official - Last Name:THAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-786-8110
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-0803
Mailing Address - Country:US
Mailing Address - Phone:803-786-8110
Mailing Address - Fax:803-735-3302
Practice Address - Street 1:710C UNIVERSITY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7611
Practice Address - Country:US
Practice Address - Phone:803-786-8100
Practice Address - Fax:803-735-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC780131Medicaid
SC780131Medicaid