Provider Demographics
NPI:1891877338
Name:HARTSVILLE DRUG CO., INC.
Entity Type:Organization
Organization Name:HARTSVILLE DRUG CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-332-6581
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-0158
Mailing Address - Country:US
Mailing Address - Phone:843-332-6581
Mailing Address - Fax:843-332-7783
Practice Address - Street 1:134 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4216
Practice Address - Country:US
Practice Address - Phone:843-332-6581
Practice Address - Fax:843-332-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50000074332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC600745Medicaid
SC600745Medicaid