MEDICARE: PIGGLY WIGGLY HOLLYWOOD INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	5001839	SC
2	3336C0003X	Community/Retail Pharmacy	5001839	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689731705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIGGLY WIGGLY HOLLYWOOD INC

Provider Business Mailing Address
First Line	:	PO BOX 118047
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29423-8047
Country	:	US
Telephone Number	:	843-554-9880
Fax Number	:	843-202-8211

Provider Business Practice Location Address
First Line	:	6251 HIGHWAY 162
Second Line	:
City	:	HOLLYWOOD
State	:	SC
Zip	:	29449-5782
Country	:	US
Telephone Number	:	843-889-6866
Fax Number	:	843-889-4976

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. DAVID R. SCHOOLS
Credential	:
Telephone Number	:	843-554-9880

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/01/2011

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