Provider Demographics
NPI:1790316719
Name:CUSTOM PHARMACY OF NORTH AUGUSTA
Entity Type:Organization
Organization Name:CUSTOM PHARMACY OF NORTH AUGUSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/ CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:FORDHAM BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-945-8351
Mailing Address - Street 1:401 W MARTINTOWN RD STE 153
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6135
Mailing Address - Country:US
Mailing Address - Phone:803-693-5514
Mailing Address - Fax:803-792-9066
Practice Address - Street 1:401 W MARTINTOWN RD STE 153
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6135
Practice Address - Country:US
Practice Address - Phone:803-693-5514
Practice Address - Fax:803-792-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy