Healthcare Provider Details

I. General information

NPI: 1275596876
Provider Name (Legal Business Name): MULLINS DISCOUNT DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S MAIN ST
MULLINS SC
29574-3112
US

IV. Provider business mailing address

310 S MAIN ST
MULLINS SC
29574-3112
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-1757
  • Fax: 843-464-1751
Mailing address:
  • Phone: 843-464-1757
  • Fax: 843-464-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50-0006374
License Number StateSC

VIII. Authorized Official

Name: MR. WILLIAM ROGER BROWN JR.
Title or Position: PIC/OWNER
Credential:
Phone: 843-464-1757