Healthcare Provider Details

I. General information

NPI: 1104558808
Provider Name (Legal Business Name): PETS INC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ORCHARD DR
WEST COLUMBIA SC
29170-3360
US

IV. Provider business mailing address

300 ORCHARD DR
WEST COLUMBIA SC
29170-3360
US

V. Phone/Fax

Practice location:
  • Phone: 803-445-5224
  • Fax:
Mailing address:
  • Phone: 803-445-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KIMBERLY KEENEY
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 803-445-5224