Provider Demographics
NPI:1710020714
Name:CASH DISCOUNTDRUGSTOREINC
Entity Type:Organization
Organization Name:CASH DISCOUNTDRUGSTOREINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEROW
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-563-3034
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-0026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 N PARLER AVE
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477
Practice Address - Country:US
Practice Address - Phone:843-563-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001938333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC719388Medicaid
SC719388Medicaid