Provider Demographics
NPI:1679840490
Name:BI-LO PHARMACY
Entity Type:Organization
Organization Name:BI-LO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIFSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-761-5506
Mailing Address - Street 1:110 S HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3954
Mailing Address - Country:US
Mailing Address - Phone:843-761-5506
Mailing Address - Fax:843-761-0965
Practice Address - Street 1:110 S HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3954
Practice Address - Country:US
Practice Address - Phone:843-761-5506
Practice Address - Fax:843-761-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9437333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9437OtherLLR