Provider Demographics
NPI:1336217132
Name:GEORGE PARKS PHARMACY INC
Entity Type:Organization
Organization Name:GEORGE PARKS PHARMACY INC
Other - Org Name:PARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-279-7450
Mailing Address - Street 1:437 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3851
Mailing Address - Country:US
Mailing Address - Phone:803-279-7450
Mailing Address - Fax:803-278-3018
Practice Address - Street 1:437 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3851
Practice Address - Country:US
Practice Address - Phone:803-279-7450
Practice Address - Fax:803-278-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
SC20293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC603822Medicaid
2089685OtherPK
SC603822Medicaid