Healthcare Provider Details

I. General information

NPI: 1154400752
Provider Name (Legal Business Name): PROPP DRUGS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 N FANT ST
ANDERSON SC
29621-4707
US

IV. Provider business mailing address

1529 N FANT ST
ANDERSON SC
29621-4707
US

V. Phone/Fax

Practice location:
  • Phone: 864-226-8383
  • Fax: 864-226-8355
Mailing address:
  • Phone: 864-226-8383
  • Fax: 864-226-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number005481
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005481
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier726863
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier0592080001
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN
# 3
IdentifierQ409550001
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerPTAN/FLU
# 4
Identifier4202230
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerNABP

VIII. Authorized Official

Name: MR. WILLIAM LEE PROPP
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 864-226-8383