# SOUTH CHURCH HEALTH MART PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTH CHURCH HEALTH MART PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073780623
- **Authorized official:** DIANDRA BROOKS PHRMD (MANAGING MEMBER)
- **Authorized official phone:** (864) 641-5351

## Contact information

- **Practice address:** 550 S CHURCH ST, UNIT \#9, SPARTANBURG, SC 29306-3306
- **Practice address phone:** (864) 596-4501
- **Practice address fax:** (864) 596-4503
- **Mailing address:** 550 S CHURCH ST, UNIT \#9, SPARTANBURG, SC 29306-3306
- **Mailing address phone:** (864) 596-4501
- **Mailing address fax:** (864) 596-4503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 10246 | SC | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 12/16/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4227751 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |