=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962975888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWDERSVILLE FAMILY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2019
-----------------------------------------------------
Last Update Date | 05/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11061 ANDERSON ROAD
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-373-9229
-----------------------------------------------------
Fax | 864-751-5795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51406
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-373-9229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | BHAVIK KANTIBHAI JOSHI
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 864-373-9229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------