MEDICARE: PAWLEYS ISLAND 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	3336C0003X	Community/Retail Pharmacy	50004654	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2091642	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861586075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAWLEYS ISLAND PHARMACY LLC

Provider Business Mailing Address
First Line	:	9710 OCEAN HWY # 17
Second Line	:	UNIT 1
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7585
Country	:	US
Telephone Number	:	843-235-4666
Fax Number	:	843-235-9630

Provider Business Practice Location Address
First Line	:	9710 OCEAN HWY # 17
Second Line	:	UNIT 1
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7585
Country	:	US
Telephone Number	:	843-235-4666
Fax Number	:	843-235-9630

Authorized Official
Title or Position	:	PRES
Name	:	GLENN COX
Credential	:
Telephone Number	:	843-235-4666

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/08/2015

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Directions to “PAWLEYS ISLAND PHARMACY LLC ” Practice Location

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