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General NPI Number Information
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NPI Number | 1982974390
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Entity Type | Organization
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Legal Business Name | SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 100 E WOOD ST STE 101
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City | SPARTANBURG
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State | SC
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Zip | 29303-3001
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Country | US
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Telephone | 864-560-6772
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Fax | 864-560-7026
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Provider Business Mailing Address
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Address Line | 100 E WOOD ST STE 101
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City | SPARTANBURG
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State | SC
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Zip | 29303-3001
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Country | US
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Telephone | 864-560-6772
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Fax | 864-560-7026
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Authorized Official
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Title or Position | OPERATIONS MANAGER RETAIL PHARMACY
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Name | DR. TIMOTHY GENTILCORE
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Credential | PHARMD
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Telephone | 864-560-9212
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13640
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License Number State | SC
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