Provider Demographics
NPI:1750397089
Name:DRUCKER DRUGS AND MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:DRUCKER DRUGS AND MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:KELLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-372-1345
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3426
Mailing Address - Country:US
Mailing Address - Phone:843-354-9582
Mailing Address - Fax:843-354-6080
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3426
Practice Address - Country:US
Practice Address - Phone:843-354-9582
Practice Address - Fax:843-354-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC045049650332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME138Medicaid
SC5296410001Medicare ID - Type Unspecified
SCDME138Medicaid