Healthcare Provider Details

I. General information

NPI: 1083134837
Provider Name (Legal Business Name): ROY NORBERT FLYNN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 S MAIN ST
SUMTER SC
29150-5245
US

IV. Provider business mailing address

32 S MAIN ST
SUMTER SC
29150-5245
US

V. Phone/Fax

Practice location:
  • Phone: 803-968-7000
  • Fax:
Mailing address:
  • Phone: 803-968-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5280
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number005280
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: