Provider Demographics
NPI: | 1598995367 |
---|---|
Name: | CHILDRENS CARE #2 |
Entity Type: | Organization |
Organization Name: | CHILDRENS CARE #2 |
Other - Org Name: | T&B INC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | LEWIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH,CDM |
Authorized Official - Phone: | 843-395-6020 |
Mailing Address - Street 1: | 203 S MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | DARLINGTON |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29532-3953 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-395-6020 |
Mailing Address - Fax: | 943-395-2595 |
Practice Address - Street 1: | 203 S MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | DARLINGTON |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29532-3953 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-395-6020 |
Practice Address - Fax: | 943-395-2595 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-07-15 |
Last Update Date: | 2009-07-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 4443 | 183500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty |