Provider Demographics
NPI:1851389159
Name:MEDI-FARE DRUG & HOME HEALTH CENTER INC
Entity Type:Organization
Organization Name:MEDI-FARE DRUG & HOME HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGA-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:864-839-6384
Mailing Address - Street 1:300 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1548
Mailing Address - Country:US
Mailing Address - Phone:864-839-6500
Mailing Address - Fax:864-839-3513
Practice Address - Street 1:300 W PINE ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-1548
Practice Address - Country:US
Practice Address - Phone:864-839-6500
Practice Address - Fax:864-839-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2372Medicaid
SCDE2372Medicaid