Provider Demographics
NPI:1821524067
Name:THREE RIVERS MIDLANDS
Entity Type:Organization
Organization Name:THREE RIVERS MIDLANDS
Other - Org Name:THREE RIVERS MIDLANDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CRANDALL
Authorized Official - Last Name:DANSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-727-1358
Mailing Address - Street 1:200 ERMINE RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2024
Mailing Address - Country:US
Mailing Address - Phone:803-791-9918
Mailing Address - Fax:803-926-5934
Practice Address - Street 1:200 ERMINE RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2024
Practice Address - Country:US
Practice Address - Phone:803-791-9918
Practice Address - Fax:803-926-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRTF-0018323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility