Provider Demographics
NPI:1851498794
Name:ORANGEBURG PHARMACY INC
Entity Type:Organization
Organization Name:ORANGEBURG PHARMACY INC
Other - Org Name:ORANGEBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-534-5727
Mailing Address - Street 1:PO BOX 1425
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6070
Practice Address - Country:US
Practice Address - Phone:803-534-5727
Practice Address - Fax:803-531-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC18123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4205971OtherNCPDP PROVIDER IDENTIFICATION NUMBER
SC718123Medicaid
SC603617Medicaid
0524630001Medicare NSC