Provider Demographics
NPI:1558386060
Name:THOMAS DRUG STORE INC
Entity Type:Organization
Organization Name:THOMAS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-475-9665
Mailing Address - Street 1:203 W MARION ST
Mailing Address - Street 2:P O BOX 218
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1412
Mailing Address - Country:US
Mailing Address - Phone:803-475-9665
Mailing Address - Fax:803-475-0669
Practice Address - Street 1:203 W MARION ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1412
Practice Address - Country:US
Practice Address - Phone:803-475-9665
Practice Address - Fax:803-475-0669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50004381332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC601110Medicaid
SC743812Medicaid
SC601110Medicaid
0439380001Medicare NSC