Healthcare Provider Details

I. General information

NPI: 1104237924
Provider Name (Legal Business Name): PARKWAY DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 HIGHWAY 9 E BLDG D SUITE 9
LONGS SC
29568-5725
US

IV. Provider business mailing address

2126 HIGHWAY 9 E BLDG D SUITE 9
LONGS SC
29568-5725
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-9800
  • Fax:
Mailing address:
  • Phone: 843-399-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number15212
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15212
License Number StateSC

VIII. Authorized Official

Name: MR. KAYODE SIKIRU ODEDIRAN
Title or Position: OWNWER
Credential: PHARMACIST
Phone: 843-399-9800