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General NPI Number Information
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NPI Number | 1104924141
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Entity Type | Organization
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Legal Business Name | PIGGLY WIGGLY OF WESTMART INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1011 BROAD ST
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City | SUMTER
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State | SC
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Zip | 29150-2504
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Country | US
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Telephone | 803-773-6378
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Fax | 803-775-6771
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Provider Business Mailing Address
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Address Line | 1011 BROAD ST
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City | SUMTER
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State | SC
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Zip | 29150-2504
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Country | US
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Telephone | 803-773-6378
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Fax | 803-775-6771
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | OLIVE DUBOSE
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Credential | PHARMD
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Telephone | 803-773-6378
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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 | 50002786
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License Number State | SC
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