Provider Demographics
NPI:1568692994
Name:PIGGLY WIGGLY NO.41, INC.
Entity Type:Organization
Organization Name:PIGGLY WIGGLY NO.41, INC.
Other - Org Name:PIGGLY WIGGLY PHARMACY #41
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-9880
Mailing Address - Street 1:PO BOX 118047
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8047
Mailing Address - Country:US
Mailing Address - Phone:843-554-9880
Mailing Address - Fax:843-202-8211
Practice Address - Street 1:9616 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3501
Practice Address - Country:US
Practice Address - Phone:843-797-8510
Practice Address - Fax:843-797-0128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIGGLY WIGGLY CAROLINA COMPANY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-20
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5007349332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC773498Medicaid
SC56310600001Medicare UPIN