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NPI Code Detail

MEDICARE: BLACKS DRUG STORE, INC

MEDICARE: BLACKS DRUG STORE, 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
1332B00000XDurable Medical Equipment & Medical Supplies600807SC

Other Identifiers

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

General Provider Information

NPI Number : 1760678361
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACKS DRUG STORE, INC
Provider Business Mailing Address
First Line : 121 CHURCH ST
Second Line :
City : CHESTER
State : SC
Zip : 29706-2903
Country : US
Telephone Number : 803-581-2102
Fax Number : 803-581-2121
Provider Business Practice Location Address
First Line : 121 CHURCH ST
Second Line :
City : CHESTER
State : SC
Zip : 29706-2903
Country : US
Telephone Number : 803-581-2102
Fax Number : 803-581-2121
Authorized Official
Title or Position : PRESIDENT
Name : ROBERT KEELS WYLIE
Credential : RPH
Telephone Number : 803-581-2102
Provider Enumeration Date : 09/18/2007
Last Update Date : 09/18/2007

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Directions to “BLACKS DRUG STORE, INC ” Practice Location

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