MEDICARE: SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT 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
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy	10237	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2125027	OTHER		PK
3	10237	OTHER	SC	SC BOARD OF PHARMACY

General Provider Information

NPI Number	:	1942270582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INC

Provider Business Mailing Address
First Line	:	380 SERPENTINE DR
Second Line	:	STE 201
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-3066
Country	:	US
Telephone Number	:	864-560-1864
Fax Number	:	864-560-0864

Provider Business Practice Location Address
First Line	:	380 SERPENTINE DR
Second Line	:	STE 201
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-3066
Country	:	US
Telephone Number	:	864-560-1864
Fax Number	:	864-560-0864

Authorized Official
Title or Position	:	OPERATIONS MANAGER - RETAIL PHARMAC
Name	:	TIMOTHY GENTILCORE
Credential	:	PHARMD
Telephone Number	:	864-560-1864

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	06/07/2022

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Directions to “SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INC ” Practice Location

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