Healthcare Provider Details

I. General information

NPI: 1346432192
Provider Name (Legal Business Name): TOWN AND COUNTRY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 MAIN ST N
NEW ELLENTON SC
29809-2534
US

IV. Provider business mailing address

PO BOX 442
NEW ELLENTON SC
29809-0442
US

V. Phone/Fax

Practice location:
  • Phone: 803-652-3006
  • Fax: 803-652-3036
Mailing address:
  • Phone: 803-652-3006
  • Fax: 803-652-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number010100
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA MARIA HALTIWANGER
Title or Position: OWNER
Credential: PHARMD
Phone: 803-644-6721