Provider Demographics
NPI:1649227133
Name:LANDRUM DRUG INC
Entity Type:Organization
Organization Name:LANDRUM DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-457-2401
Mailing Address - Street 1:104 W RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356
Mailing Address - Country:US
Mailing Address - Phone:864-457-2401
Mailing Address - Fax:864-457-2583
Practice Address - Street 1:104 W RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356
Practice Address - Country:US
Practice Address - Phone:864-457-2401
Practice Address - Fax:864-457-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC724820Medicaid
SC0131790001Medicare ID - Type Unspecified