Provider Demographics
NPI:1912198623
Name:COMMUNITY MEDICINE FOUNDATION
Entity Type:Organization
Organization Name:COMMUNITY MEDICINE FOUNDATION
Other - Org Name:COMMUNITY MEDICINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-325-7744
Mailing Address - Street 1:423 SALUDA STREET P. O. BOX 28
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-6028
Mailing Address - Country:US
Mailing Address - Phone:803-412-3352
Mailing Address - Fax:803-412-3353
Practice Address - Street 1:423 SALUDA STREET
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5776
Practice Address - Country:US
Practice Address - Phone:803-412-3352
Practice Address - Fax:803-412-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC795622Medicaid