Healthcare Provider Details

I. General information

NPI: 1689731705
Provider Name (Legal Business Name): PIGGLY WIGGLY HOLLYWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6251 HIGHWAY 162
HOLLYWOOD SC
29449-5782
US

IV. Provider business mailing address

PO BOX 118047
CHARLESTON SC
29423-8047
US

V. Phone/Fax

Practice location:
  • Phone: 843-889-6866
  • Fax: 843-889-4976
Mailing address:
  • Phone: 843-554-9880
  • Fax: 843-202-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5001839
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5001839
License Number StateSC

VIII. Authorized Official

Name: MR. DAVID R. SCHOOLS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 843-554-9880