Provider Demographics
NPI:1841527785
Name:RIDGELAND DRUG COMPANY INC
Entity type:Organization
Organization Name:RIDGELAND DRUG COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-645-0800
Mailing Address - Street 1:149 RIVERWALK BLVD
Mailing Address - Street 2:SUITE 18, BOX 191
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8190
Mailing Address - Country:US
Mailing Address - Phone:843-645-0800
Mailing Address - Fax:843-645-0801
Practice Address - Street 1:149 RIVERWALK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8191
Practice Address - Country:US
Practice Address - Phone:843-645-0800
Practice Address - Fax:843-645-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
SCPY 107043336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4229351OtherNCPDP PROVIDER IDENTIFICATION NUMBER