MEDICARE: SUMTER CUT RATE DRUG STORE, LLC

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
2	253Z00000X	In Home Supportive Care Agency
3	333600000X	Pharmacy
4	261Q00000X	Clinic/Center	50005096	SC
5	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1770563231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMTER CUT RATE DRUG STORE, LLC

Provider Business Mailing Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-5245
Country	:	US
Telephone Number	:	803-773-8432
Fax Number	:	803-436-5533

Provider Business Practice Location Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-5245
Country	:	US
Telephone Number	:	803-773-8432
Fax Number	:	803-436-5533

Authorized Official
Title or Position	:	OWNER
Name	:	ROY NORBERT FLYNN
Credential	:
Telephone Number	:	803-968-7000

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	03/09/2026

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