Provider Demographics
NPI:1023176658
Name:ELGIN PHARMACY, INC.
Entity type:Organization
Organization Name:ELGIN PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAISHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-438-5735
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-0749
Mailing Address - Country:US
Mailing Address - Phone:803-438-5735
Mailing Address - Fax:803-438-4657
Practice Address - Street 1:1107 ROSS ST.
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045
Practice Address - Country:US
Practice Address - Phone:803-438-5735
Practice Address - Fax:803-438-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC720376Medicaid
SC720376Medicaid