Healthcare Provider Details

I. General information

NPI: 1982919874
Provider Name (Legal Business Name): P I STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 CONGAREE RD
GREENVILLE SC
29607-3518
US

IV. Provider business mailing address

2532 JOHNS PLACE
JAMESTOWN NY
14701
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-0477
  • Fax: 716-708-6248
Mailing address:
  • Phone: 716-720-5121
  • Fax: 716-708-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number10460
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MOON
Title or Position: OWNER
Credential:
Phone: 716-720-5121