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General NPI Number Information
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NPI Number | 1740788066
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Entity Type | Organization
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Legal Business Name | ZIVITSKI HEALTH GROUP LLC
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 345 W MAIN STREET
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City | GRAY COURT
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State | SC
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Zip | 29645
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Country | US
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Telephone | 864-876-3837
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Fax | 864-876-1137
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | GRAY COURT
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State | SC
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Zip | 29645-0096
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Country | US
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Telephone | 864-876-3837
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Fax | 864-876-1137
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Authorized Official
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Title or Position | OWNER
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Name | RONALD ZIVITSKI
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Credential |
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Telephone | 864-876-3837
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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 | 17663
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License Number State | SC
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