Provider Demographics
NPI:1639276561
Name:PALMETTO STATE PHARMACEUTICALS INC
Entity Type:Organization
Organization Name:PALMETTO STATE PHARMACEUTICALS INC
Other - Org Name:PRIMARYRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY RX
Authorized Official - Prefix:
Authorized Official - First Name:NIKKEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-769-7633
Mailing Address - Street 1:2000 SAM RITTENBERG BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4629
Mailing Address - Country:US
Mailing Address - Phone:843-769-7633
Mailing Address - Fax:843-769-7693
Practice Address - Street 1:2000 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4629
Practice Address - Country:US
Practice Address - Phone:843-769-7633
Practice Address - Fax:843-769-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88313336M0002X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093087OtherPK