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General NPI Number Information
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NPI Number | 1104913300
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Entity Type | Organization
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Legal Business Name | MARLBORO DRUG COMPANY
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 12/31/2022
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Provider Practice Location Address
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Address Line | 113 N MARLBORO ST
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-3142
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Country | US
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Telephone | 843-479-4248
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Fax | 843-479-3640
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-0091
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Country | US
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Telephone | 843-479-4248
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Fax | 843-479-3640
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Authorized Official
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Title or Position | PIC
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Name | JON T LEE
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Credential |
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Telephone | 843-479-4248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50003505
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License Number State | SC
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