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General NPI Number Information
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NPI Number | 1366531055
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Entity Type | Organization
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Legal Business Name | IRMO FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 7001 ST ANDREWS RD A-16
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City | COLUMBIA
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State | SC
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Zip | 29212
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Country | US
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Telephone | 803-749-9988
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Fax | 803-749-9096
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Provider Business Mailing Address
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Address Line | 7001 ST ANDREWS RD A-16
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City | COLUMBIA
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State | SC
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Zip | 29212
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Country | US
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Telephone | 803-749-9988
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Fax | 803-749-9096
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP D MIMS
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Credential |
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Telephone | 803-917-3627
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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 | 50007248
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License Number State | SC
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 50009341
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License Number State | SC
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