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General NPI Number Information
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NPI Number | 1467002816
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Entity Type | Organization
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Legal Business Name | BLACK RIVER PHARMACY LLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 32A N WILLIAMSBURG COUNTY HWY
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City | KINGSTREE
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State | SC
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Zip | 29556-2433
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Country | US
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Telephone | 843-355-5656
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Fax | 843-355-5655
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Provider Business Mailing Address
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Address Line | 32A N WILLIAMSBURG COUNTY HWY
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City | KINGSTREE
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State | SC
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Zip | 29556-2433
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Country | US
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Telephone | 843-355-5656
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Fax | 843-355-5655
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL EDWARD DRUCKER
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Credential | RPH.
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Telephone | 843-356-0172
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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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