Provider Demographics
NPI:1831218429
Name:REYNOLDS DRUG STORE, INC.
Entity type:Organization
Organization Name:REYNOLDS DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:843-264-5454
Mailing Address - Street 1:7 S MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-2645
Mailing Address - Country:US
Mailing Address - Phone:843-264-5454
Mailing Address - Fax:843-264-8362
Practice Address - Street 1:7 S MORGAN AVE
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-2645
Practice Address - Country:US
Practice Address - Phone:843-264-5454
Practice Address - Fax:843-264-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-000630332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1728Medicaid
4202292OtherNACPDP NUMBER
SC706307Medicaid
SCDE1728Medicaid
SC1057200001Medicare NSC