Healthcare Provider Details

I. General information

NPI: 1477679843
Provider Name (Legal Business Name): MEDI FARE DRUG AND HOME HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
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: 864-839-6384
  • Fax: 864-839-3513
Mailing address:
  • Phone: 864-839-6384
  • Fax: 864-839-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50008084
License Number StateSC

VIII. Authorized Official

Name: MS. PATRICIA BALOGA
Title or Position: OWNER PHARMACIST
Credential: PHARM D
Phone: 864-839-6384