Healthcare Provider Details

I. General information

NPI: 1215973334
Provider Name (Legal Business Name): PUGH DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST
PROSPERITY SC
29127
US

IV. Provider business mailing address

PO BOX 147
PROSPERITY SC
29127-0147
US

V. Phone/Fax

Practice location:
  • Phone: 803-364-2310
  • Fax: 803-364-2311
Mailing address:
  • Phone: 803-364-2310
  • Fax: 803-364-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8757
License Number StateSC

VIII. Authorized Official

Name: JOHN PUGH
Title or Position: PRESIDENT PIC
Credential: PHARMD RPH
Phone: 803-364-2310