Healthcare Provider Details

I. General information

NPI: 1356393771
Provider Name (Legal Business Name): BRIDGERS DRUG STORE & GIFTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MAIN ST
MARION SC
29571-3027
US

IV. Provider business mailing address

PO BOX 850
MARION SC
29571-0850
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-2682
  • Fax: 843-423-2429
Mailing address:
  • Phone: 843-423-2682
  • Fax: 843-423-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRENT A HASTY
Title or Position: OWNER
Credential: PHARMD
Phone: 843-423-2682