=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588761423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWERS PHARMACY OF LORIS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3985 MEETING ST
-----------------------------------------------------
City | LORIS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29569-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-756-1600
-----------------------------------------------------
Fax | 843-756-3382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3985 MEETING ST
-----------------------------------------------------
City | LORIS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29569-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-756-1600
-----------------------------------------------------
Fax | 843-756-3382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CHF PHARM
-----------------------------------------------------
Name | LLOYD POWERS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 843-756-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 14112
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------