MEDICARE: BLOCKER & TIMMERMAN DRUG CO.,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	333600000X	Pharmacy	50-000987	SC
2	332B00000X	Durable Medical Equipment & Medical Supplies	50-000987	SC

General Provider Information

NPI Number	:	1164426938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOCKER & TIMMERMAN DRUG CO.,INC.

Provider Business Mailing Address
First Line	:	300 MAIN ST
Second Line	:
City	:	EDGEFIELD
State	:	SC
Zip	:	29824-1326
Country	:	US
Telephone Number	:	803-637-6155
Fax Number	:	803-637-3753

Provider Business Practice Location Address
First Line	:	300 MAIN ST
Second Line	:
City	:	EDGEFIELD
State	:	SC
Zip	:	29824-1326
Country	:	US
Telephone Number	:	803-637-6155
Fax Number	:	803-637-3753

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JACK B. HODGE
Credential	:	R.PH.
Telephone Number	:	803-637-6155

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/11/2025

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