Provider Demographics
NPI:1710086194
Name:CALLAWAY'S PHARMACY
Entity Type:Organization
Organization Name:CALLAWAY'S PHARMACY
Other - Org Name:BRYAN E CALLAWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-418-8581
Mailing Address - Street 1:546 E SAVANNAH ST
Mailing Address - Street 2:
Mailing Address - City:CALHOUN FALLS
Mailing Address - State:SC
Mailing Address - Zip Code:29628-1239
Mailing Address - Country:US
Mailing Address - Phone:864-418-8581
Mailing Address - Fax:864-418-8583
Practice Address - Street 1:546 E SAVANNAH ST
Practice Address - Street 2:
Practice Address - City:CALHOUN FALLS
Practice Address - State:SC
Practice Address - Zip Code:29628-1239
Practice Address - Country:US
Practice Address - Phone:864-418-8581
Practice Address - Fax:864-418-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50001784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
42-02622OtherNABP
SC717846Medicaid