Provider Demographics
NPI:1891846879
Name:SOUTH CAROLINA ERICA, INC.
Entity Type:Organization
Organization Name:SOUTH CAROLINA ERICA, INC.
Other - Org Name:FOOD BASKET PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RX SERVICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:325-658-6551
Mailing Address - Street 1:104 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4702
Mailing Address - Country:US
Mailing Address - Phone:432-837-1994
Mailing Address - Fax:432-837-2235
Practice Address - Street 1:104 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4702
Practice Address - Country:US
Practice Address - Phone:432-837-1994
Practice Address - Fax:432-837-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145114Medicaid