Provider Demographics
NPI:1629770532
Name:FOOTHILLS COMMUNITY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:FOOTHILLS COMMUNITY HEALTH CARE, INC.
Other - Org Name:FOOTHILLS CLEMSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RAJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-722-0283
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-0311
Mailing Address - Country:US
Mailing Address - Phone:864-633-5171
Mailing Address - Fax:
Practice Address - Street 1:110 LIBERTY DR STE 200
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-3159
Practice Address - Country:US
Practice Address - Phone:864-633-5171
Practice Address - Fax:864-261-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy