Provider Demographics
NPI:1831167873
Name:DISCOUNT DRUG OF SWANSEA, INC
Entity type:Organization
Organization Name:DISCOUNT DRUG OF SWANSEA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BUCK
Authorized Official - Last Name:RAY
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-568-3251
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-0985
Mailing Address - Country:US
Mailing Address - Phone:803-568-3251
Mailing Address - Fax:803-568-7590
Practice Address - Street 1:400 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-0985
Practice Address - Country:US
Practice Address - Phone:803-568-3251
Practice Address - Fax:803-568-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50004013333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3157Medicaid
SC740135Medicaid