Healthcare Provider Details

I. General information

NPI: 1386789915
Provider Name (Legal Business Name): THE MEDICINE SHOPPE #1425
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HWY 301 SOUTH
DILLON SC
29536-3447
US

IV. Provider business mailing address

101 HWY 301 SOUTH PO BOX 867
DILLON SC
29536-3447
US

V. Phone/Fax

Practice location:
  • Phone: 843-841-9600
  • Fax: 843-774-3860
Mailing address:
  • Phone: 843-841-9600
  • Fax: 843-774-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7462
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50003431
License Number StateSC

VIII. Authorized Official

Name: MS. LISA CREECH DOUGLAS
Title or Position: CEO
Credential: RPH
Phone: 843-841-9600