Provider Demographics
NPI:1578506853
Name:MED CENTER PHARMACY & MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MED CENTER PHARMACY & MEDICAL SUPPLY LLC
Other - Org Name:MED CENTER LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-398-7015
Mailing Address - Street 1:209 RUSSELL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3311
Mailing Address - Country:US
Mailing Address - Phone:843-398-7015
Mailing Address - Fax:843-398-2017
Practice Address - Street 1:209 RUSSELL ST
Practice Address - Street 2:SUITE C
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3311
Practice Address - Country:US
Practice Address - Phone:843-398-7015
Practice Address - Fax:843-398-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC785920Medicaid
2092976OtherPK