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General NPI Number Information
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NPI Number | 1417951252
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Entity Type | Organization
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Legal Business Name | SUP-RX PHARMACY #53
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 401 PEARL ST
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City | DARLINGTON
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State | SC
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Zip | 29532-3814
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Country | US
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Telephone | 843-393-2552
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Fax | 843-393-9811
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Provider Business Mailing Address
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Address Line | 401 PEARL ST
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City | DARLINGTON
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State | SC
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Zip | 29532-3814
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Country | US
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Telephone | 843-393-2552
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Fax | 843-393-9811
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Authorized Official
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Title or Position | OWNER
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Name | RICKY MCLEOD
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Credential |
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Telephone | 803-775-1334
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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 | 50-000803
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License Number State | SC
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