Provider Demographics
NPI:1649834045
Name:GROVE PARK PHARMACY HOME CARE, LLC
Entity type:Organization
Organization Name:GROVE PARK PHARMACY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-536-6644
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0701
Mailing Address - Country:US
Mailing Address - Phone:803-536-6644
Mailing Address - Fax:803-937-1528
Practice Address - Street 1:1353 GROVE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-2455
Practice Address - Country:US
Practice Address - Phone:803-536-6644
Practice Address - Fax:803-937-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health