Provider Demographics
NPI:1912126707
Name:PROFESSIONAL PHARMACY OF GREER, INC
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY OF GREER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:R PHARMACISTS
Authorized Official - Phone:864-877-3386
Mailing Address - Street 1:320 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1521
Mailing Address - Country:US
Mailing Address - Phone:864-877-3386
Mailing Address - Fax:864-877-3859
Practice Address - Street 1:320 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1521
Practice Address - Country:US
Practice Address - Phone:864-877-3386
Practice Address - Fax:864-877-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC610743Medicaid