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General NPI Number Information
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NPI Number | 1528041373
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Entity Type | Organization
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Legal Business Name | MED MART LEX
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 348B COLUMBIA AVE
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City | LEXINGTON
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State | SC
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Zip | 29072-2657
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Country | US
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Telephone | 803-957-5969
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Fax | 803-808-1829
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Provider Business Mailing Address
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Address Line | 348B COLUMBIA AVE
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City | LEXINGTON
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State | SC
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Zip | 29072-2657
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Country | US
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Telephone | 803-957-5969
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Fax | 803-808-1829
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL GLEATON
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Credential |
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Telephone | 803-957-5969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16242
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License Number State | SC
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