Healthcare Provider Details

I. General information

NPI: 1033131602
Provider Name (Legal Business Name): STROM'S DRUG STORE #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S MAIN ST
MCCORMICK SC
29835
US

IV. Provider business mailing address

124 SOUTH MAIN STREET P.O. BOX 1838
MC CORMICK SC
29835
US

V. Phone/Fax

Practice location:
  • Phone: 864-465-2011
  • Fax: 864-465-3150
Mailing address:
  • Phone: 864-465-2011
  • Fax: 864-465-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROY NORBERT FLYNN JR.
Title or Position: VP
Credential: RPH
Phone: 803-968-7000