Provider Demographics
NPI:1649670969
Name:PRIVILEGE PHARMACY INC
Entity type:Organization
Organization Name:PRIVILEGE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EIPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-252-8843
Mailing Address - Street 1:3311 PLATT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2203
Mailing Address - Country:US
Mailing Address - Phone:803-708-1226
Mailing Address - Fax:803-708-1229
Practice Address - Street 1:3311 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2203
Practice Address - Country:US
Practice Address - Phone:803-708-1226
Practice Address - Fax:803-708-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC715359Medicaid
SC7268150001Medicare NSC