Healthcare Provider Details

I. General information

NPI: 1558572362
Provider Name (Legal Business Name): ELGIN PHARAMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 ROSS ST.
ELGIN SC
29045
US

IV. Provider business mailing address

PO BOX 749 1107 ROSS ST.
ELGIN SC
29045-0749
US

V. Phone/Fax

Practice location:
  • Phone: 803-438-5732
  • Fax: 803-438-4657
Mailing address:
  • Phone: 803-438-5732
  • Fax: 803-438-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number50002037
License Number StateSC

VIII. Authorized Official

Name: FREDDY MUBARAK
Title or Position: PHARMACIST
Credential: RPH
Phone: 803-438-5735