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General NPI Number Information
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NPI Number | 1700881943
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Entity Type | Organization
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Legal Business Name | LORIS DRUG STORE, INC.
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 4125 MAIN ST
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City | LORIS
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State | SC
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Zip | 29569-3023
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Country | US
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Telephone | 843-756-4021
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Fax | 843-756-9124
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Provider Business Mailing Address
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Address Line | 4125 MAIN ST
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City | LORIS
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State | SC
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Zip | 29569-3023
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Country | US
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Telephone | 843-756-4021
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Fax | 832-756-9124
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS SINGLETON BAILEY
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Credential |
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Telephone | 843-756-4021
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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 | 50001951
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License Number State | SC
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