Provider Demographics
NPI:1962486696
Name:MCLESKEY-TODD PHARMACY OF GREER INC
Entity Type:Organization
Organization Name:MCLESKEY-TODD PHARMACY OF GREER INC
Other - Org Name:MCLESKEY TODD PHARMACY OF GREER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-877-0753
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1921
Mailing Address - Country:US
Mailing Address - Phone:864-877-0753
Mailing Address - Fax:864-877-5171
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1921
Practice Address - Country:US
Practice Address - Phone:864-877-0753
Practice Address - Fax:864-877-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
SC143183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC714319Medicaid
2090110OtherPK