Provider Demographics
NPI:1700876927
Name:PITT STREET PHARMACY INC
Entity Type:Organization
Organization Name:PITT STREET PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT / PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-884-4051
Mailing Address - Street 1:111 PITT ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5318
Mailing Address - Country:US
Mailing Address - Phone:843-884-4051
Mailing Address - Fax:843-884-9117
Practice Address - Street 1:111 PITT ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5318
Practice Address - Country:US
Practice Address - Phone:843-884-4051
Practice Address - Fax:843-884-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4978183500000X
SC3596333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered333600000XSuppliersPharmacy