Provider Demographics
NPI:1659465151
Name:RADHEY, LLC
Entity Type:Organization
Organization Name:RADHEY, LLC
Other - Org Name:SMITH DRUG STORE NO.1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KUNTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-237-5501
Mailing Address - Street 1:142 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5113
Mailing Address - Country:US
Mailing Address - Phone:864-583-4521
Mailing Address - Fax:864-582-0438
Practice Address - Street 1:142 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5113
Practice Address - Country:US
Practice Address - Phone:864-583-4521
Practice Address - Fax:864-582-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC154423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148301OtherPK
SC711895Medicaid
0135690001Medicare NSC