MEDICARE: PIGGLY WIGGLY MT PLEASANT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	50007503	SC
2	3336C0003X	Community/Retail Pharmacy	50007503	SC

General Provider Information

NPI Number	:	1104983287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIGGLY WIGGLY MT PLEASANT INC

Provider Business Mailing Address
First Line	:	PO BOX 118047
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29423-8047
Country	:	US
Telephone Number	:	843-554-9880
Fax Number	:	843-202-8211

Provider Business Practice Location Address
First Line	:	1981 RIVIERA DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7401
Country	:	US
Telephone Number	:	843-849-1515
Fax Number	:	843-849-2017

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID R. SCHOOLS
Credential	:
Telephone Number	:	843-554-9880

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	11/24/2010

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