Provider Demographics
NPI:1881925501
Name:SANDHILLS MEDICAL FOUNDATION, INC.
Entity type:Organization
Organization Name:SANDHILLS MEDICAL FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-438-5537
Mailing Address - Street 1:409 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29718-8701
Mailing Address - Country:US
Mailing Address - Phone:843-658-3006
Mailing Address - Fax:843-658-7811
Practice Address - Street 1:409 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:SC
Practice Address - Zip Code:29718-8701
Practice Address - Country:US
Practice Address - Phone:843-658-3006
Practice Address - Fax:843-658-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
SC107063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123401OtherPK
SC710706Medicaid