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General NPI Number Information
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NPI Number | 1912095068
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY OF MARION INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 223 N MAIN ST
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City | MARION
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State | SC
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Zip | 29571-3025
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Country | US
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Telephone | 843-423-1882
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Fax | 843-423-5006
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Provider Business Mailing Address
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Address Line | PO BOX 1109
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City | MARION
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State | SC
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Zip | 29571-1109
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Country | US
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Telephone | 843-422-1882
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Fax |
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Authorized Official
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Title or Position | VP
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Name | THOMAS FULLER
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Credential | BS PHARMACT
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Telephone | 843-423-1882
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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 | 2363
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License Number State | SC
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