Provider Demographics
NPI:1891830899
Name:GENERX PHARMACY
Entity Type:Organization
Organization Name:GENERX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-345-0708
Mailing Address - Street 1:429 E BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8388
Mailing Address - Country:US
Mailing Address - Phone:803-345-0708
Mailing Address - Fax:803-345-0057
Practice Address - Street 1:429 E BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8388
Practice Address - Country:US
Practice Address - Phone:803-345-0708
Practice Address - Fax:803-345-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500035853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC735856Medicaid
SC1164560001Medicare ID - Type Unspecified