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NPI Code Detail

MEDICARE: SUMTER CUT RATE DRUGSTORE II INC

MEDICARE: SUMTER CUT RATE DRUGSTORE II 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
13336C0003XCommunity/Retail Pharmacy5010095SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14227991OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1972750495
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMTER CUT RATE DRUGSTORE II INC
Provider Business Mailing Address
First Line : 32 S MAIN ST
Second Line :
City : SUMTER
State : SC
Zip : 29150-5245
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26 S MAIN ST
Second Line :
City : SUMTER
State : SC
Zip : 29150-5245
Country : US
Telephone Number : 803-775-0533
Fax Number : 803-436-5533
Authorized Official
Title or Position : PARTNER
Name : CHAD GIBBONS
Credential :
Telephone Number : 803-773-8432
Provider Enumeration Date : 08/27/2008
Last Update Date : 08/27/2008

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Directions to “SUMTER CUT RATE DRUGSTORE II INC ” Practice Location

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