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General NPI Number Information
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NPI Number | 1134548530
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Entity Type | Individual
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Provider Name | MR. THOMAS GROGAN
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Gender | Male
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 10820 KINGS RD
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-6070
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Country | US
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Telephone | 843-449-0508
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Fax | 843-497-8936
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Provider Business Mailing Address
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Address Line | 10820 KINGS RD
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-6070
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Country | US
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Telephone | 843-449-0508
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Fax | 843-497-8936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6018
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License Number State | SC
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