Provider Demographics
NPI:1770628653
Name:HAWTHORNE PELION PHARMACY, INC.
Entity Type:Organization
Organization Name:HAWTHORNE PELION PHARMACY, INC.
Other - Org Name:BIG S DISCOUNT DRUG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-227-4464
Mailing Address - Street 1:8073 EDMUND HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PELION
Mailing Address - State:SC
Mailing Address - Zip Code:29123-9805
Mailing Address - Country:US
Mailing Address - Phone:803-227-4464
Mailing Address - Fax:803-638-6972
Practice Address - Street 1:8073 EDMUND HIGHWAY
Practice Address - Street 2:
Practice Address - City:PELION
Practice Address - State:SC
Practice Address - Zip Code:29123-9805
Practice Address - Country:US
Practice Address - Phone:803-894-4010
Practice Address - Fax:803-894-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18414OtherPHARMACY PERMIT NUMBER
4215376OtherNCPDP
SC7Z1018Medicaid
SC721888Medicaid