=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659351427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILL STREET DRUGS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 11/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 S MILL ST
-----------------------------------------------------
City | MANNING
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29102-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-433-2212
-----------------------------------------------------
Fax | 803-433-2656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 S MILL ST
-----------------------------------------------------
City | MANNING
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29102-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-433-2212
-----------------------------------------------------
Fax | 803-433-2656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | DR. ELIZABETH PATRICK DURANT
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 803-433-2212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 50008944
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------