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General NPI Number Information
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NPI Number | 1528388279
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Entity Type | Organization
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Legal Business Name | NYES PHARMACY OF CONWAY INC
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 1600 10TH AVE
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City | CONWAY
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State | SC
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Zip | 29526-4112
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Country | US
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Telephone | 843-248-5015
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Fax | 843-488-1942
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Provider Business Mailing Address
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Address Line | 1600 10TH AVE
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City | CONWAY
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State | SC
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Zip | 29526-4112
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Country | US
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Telephone | 843-248-5015
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Fax | 843-488-1942
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | TIFFANY COMBS
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Credential |
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Telephone | 843-248-5015
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10957
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License Number State | SC
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