Provider Demographics
NPI:1760594774
Name:BULLS DRUG STORE INC
Entity Type:Organization
Organization Name:BULLS DRUG STORE INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-549-9565
Mailing Address - Street 1:1315 N JEFFERIES BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1315 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2732
Practice Address - Country:US
Practice Address - Phone:843-549-9565
Practice Address - Fax:843-549-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50005059333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4219235OtherOTHER ID NUMBER-COMMERCIAL NUMBER
SC750590Medicaid
SCBM6687163OtherDEA
SC0498140004Medicare NSC