Provider Demographics
NPI:1942241880
Name:SC HOME RX
Entity Type:Organization
Organization Name:SC HOME RX
Other - Org Name:AGAPE PHARMACY INC DBA LTC PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CPHT BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-739-4278
Mailing Address - Street 1:3685 LEAPHART RD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3067
Mailing Address - Country:US
Mailing Address - Phone:803-454-0194
Mailing Address - Fax:803-451-7128
Practice Address - Street 1:3685 LEAPHART RD STE A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3067
Practice Address - Country:US
Practice Address - Phone:803-454-0194
Practice Address - Fax:803-451-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500074573336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC774573Medicaid
SC4225137OtherNABP/NCPDP
SC4225137OtherNABP/NCPDP
SC774573Medicaid