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General NPI Number Information
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NPI Number | 1104237924
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Entity Type | Organization
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Legal Business Name | PARKWAY DISCOUNT PHARMACY
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 2126 HIGHWAY 9 E BLDG D SUITE 9
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City | LONGS
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State | SC
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Zip | 29568-5725
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Country | US
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Telephone | 843-399-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 HIGHWAY 9 E BLDG D SUITE 9
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City | LONGS
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State | SC
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Zip | 29568-5725
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Country | US
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Telephone | 843-399-9800
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Fax |
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Authorized Official
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Title or Position | OWNWER
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Name | MR. KAYODE SIKIRU ODEDIRAN
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Credential | PHARMACIST
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Telephone | 843-399-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15212
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 15212
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License Number State | SC
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