Provider Demographics
NPI:1700923117
Name:MEDCARE PHARMACY
Entity Type:Organization
Organization Name:MEDCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-479-7101
Mailing Address - Street 1:1114 COTTINGHAM BLVD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2856
Mailing Address - Country:US
Mailing Address - Phone:843-479-7101
Mailing Address - Fax:843-479-3561
Practice Address - Street 1:1114 COTTINGHAM BLVD N
Practice Address - Street 2:SUITE B
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2856
Practice Address - Country:US
Practice Address - Phone:843-479-7101
Practice Address - Fax:843-479-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4224919OtherNABP NUMBER
SCDE2410Medicaid
SCDE2410Medicaid