Provider Demographics
NPI:1710204490
Name:LOWCOUNTRY PHARMACY LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY PHARMACY LLC
Other - Org Name:LOWCOUNTRY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:843-656-2973
Mailing Address - Street 1:PO BOX 12447
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-2447
Mailing Address - Country:US
Mailing Address - Phone:843-656-2973
Mailing Address - Fax:843-656-2978
Practice Address - Street 1:1530 MCLURE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6174
Practice Address - Country:US
Practice Address - Phone:843-656-2973
Practice Address - Fax:843-656-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
SC153643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147856OtherPK
SC715364Medicaid
SCDE3531Medicaid