Healthcare Provider Details

I. General information

NPI: 1841527785
Provider Name (Legal Business Name): RIDGELAND DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 RIVERWALK BLVD STE 1
RIDGELAND SC
29936-8191
US

IV. Provider business mailing address

149 RIVERWALK BLVD SUITE 18, BOX 191
RIDGELAND SC
29936-8190
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-0800
  • Fax: 843-645-0801
Mailing address:
  • Phone: 843-645-0800
  • Fax: 843-645-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPY 10704
License Number StateSC

VIII. Authorized Official

Name: PAIGE COUPER
Title or Position: PRESIDENT
Credential:
Phone: 843-645-0800