Healthcare Provider Details

I. General information

NPI: 1023176658
Provider Name (Legal Business Name): ELGIN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 ROSS ST.
ELGIN SC
29045
US

IV. Provider business mailing address

PO BOX 749
ELGIN SC
29045-0749
US

V. Phone/Fax

Practice location:
  • Phone: 803-438-5735
  • Fax: 803-438-4657
Mailing address:
  • Phone: 803-438-5735
  • Fax: 803-438-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TRAISHA W. CAMPFIELD
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 803-438-5735