Provider Demographics
NPI:1841358108
Name:BRUNSONS PHARMACY
Entity type:Organization
Organization Name:BRUNSONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OLIN
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-435-2511
Mailing Address - Street 1:12 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3206
Mailing Address - Country:US
Mailing Address - Phone:803-435-2511
Mailing Address - Fax:803-435-4235
Practice Address - Street 1:12 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3206
Practice Address - Country:US
Practice Address - Phone:803-435-2511
Practice Address - Fax:803-435-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500002403336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC602404Medicaid
SC702402Medicaid
SC4205464OtherNCPDP
SC702402Medicaid