MEDICARE: SOUTH CHURCH HEALTH MART PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	10246	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4227751	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1073780623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CHURCH HEALTH MART PHARMACY LLC

Provider Business Mailing Address
First Line	:	550 S CHURCH ST
Second Line	:	UNIT #9
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3306
Country	:	US
Telephone Number	:	864-596-4501
Fax Number	:	864-596-4503

Provider Business Practice Location Address
First Line	:	550 S CHURCH ST
Second Line	:	UNIT #9
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3306
Country	:	US
Telephone Number	:	864-596-4501
Fax Number	:	864-596-4503

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DIANDRA BROOKS
Credential	:	PHRMD
Telephone Number	:	864-641-5351

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	12/16/2009

Similar Medicare Providers

1376594101 — DR. JANICE M WIGGINS MD
Practice Location Address:

550 S CHURCH ST STE 4
SPARTANBURG, SC
29306-3306

Practice Phone: 864-774-7001
Practice Fax: 864-499-3762

1619084308 — TISHA ABERCROMBIE WILLIAMS M.D.
Practice Location Address:

550 S CHURCH ST STE 4
SPARTANBURG, SC
29306-3306

Practice Phone: 864-774-7001
Practice Fax: 864-499-3742

1568582906 — DR. GAIL L REARDEN MD
Practice Location Address:

550 S CHURCH ST STE 4
SPARTANBURG, SC
29306-3306

Practice Phone: 864-774-7001
Practice Fax:

1659609485 — REGENESIS ORGANZATION COMMUNITY HEALTH CENTER
Practice Location Address:

550 S CHURCH STREET , UNIT 2
SPARTANBURG, SC
29306-3306

Practice Phone: 864-582-2817
Practice Fax:

1912221664 — PEAOCK MEDICAL EQUIPMENT & HOME HEALTH CARE LLC
Practice Location Address:

550 S CHURCH ST STE 11
SPARTANBURG, SC
29306-3306

Practice Phone: 864-583-7751
Practice Fax: 800-419-1565

1942528278 — PEACOCK PHARMACY LLC
Practice Location Address:

550 S CHURCH ST STE 9
SPARTANBURG, SC
29306-3306

Practice Phone: 864-596-4501
Practice Fax: 864-596-4503

Directions to “SOUTH CHURCH HEALTH MART PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.