Healthcare Provider Details

I. General information

NPI: 1851389159
Provider Name (Legal Business Name): MEDI-FARE DRUG & HOME HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W PINE ST
BLACKSBURG SC
29702-1548
US

IV. Provider business mailing address

300 W PINE ST
BLACKSBURG SC
29702-1548
US

V. Phone/Fax

Practice location:
  • Phone: 864-839-6500
  • Fax: 864-839-3513
Mailing address:
  • Phone: 864-839-6500
  • Fax: 864-839-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAT BALOGA-STEPHENS
Title or Position: OWNER/PRESIDENT
Credential: PHARM D
Phone: 864-839-6384