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General NPI Number Information
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NPI Number | 1508109497
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Entity Type | Organization
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Legal Business Name | BRUNSON'S PHARMACY, LLC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 12 N BROOKS ST SUITE 206
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City | MANNING
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State | SC
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Zip | 29102-3206
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Country | US
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Telephone | 803-435-2511
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Fax | 803-435-4235
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Provider Business Mailing Address
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Address Line | PO BOX 1250 12 N BROOKS ST
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City | MANNING
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State | SC
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Zip | 29102-1250
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Country | US
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Telephone | 803-435-2511
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES V MATHIS JR.
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Credential | PHARMD
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Telephone | 803-435-2511
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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 | 14411
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License Number State | SC
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