Provider Demographics
NPI:1669615860
Name:MJW CORPORATION
Entity type:Organization
Organization Name:MJW CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHARMACIST / PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:803-648-1776
Mailing Address - Street 1:110 PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7395
Mailing Address - Country:US
Mailing Address - Phone:803-648-1776
Mailing Address - Fax:803-649-9494
Practice Address - Street 1:110 PRICE AVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7395
Practice Address - Country:US
Practice Address - Phone:803-648-1776
Practice Address - Fax:803-649-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50103793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC710379Medicaid
SC5010379OtherSC PHARMACY PERMIT