Healthcare Provider Details

I. General information

NPI: 1396796769
Provider Name (Legal Business Name): KENS THRIFTEE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E MAIN ST
WALHALLA SC
29691-1925
US

IV. Provider business mailing address

PO BOX 58
WALHALLA SC
29691-0058
US

V. Phone/Fax

Practice location:
  • Phone: 864-638-9553
  • Fax: 864-638-3754
Mailing address:
  • Phone: 864-638-9553
  • Fax: 864-638-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8474
License Number StateSC

VIII. Authorized Official

Name: JUDSON WRIGHT
Title or Position: OWNER, CORP SEC, MGR
Credential: CPHT
Phone: 864-638-9553