# WAGENER DRUG CO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAGENER DRUG CO
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144362229
- **Authorized official:** THERESA DYCHES (OWNER)
- **Authorized official phone:** (803) 564-5381

## Contact information

- **Practice address:** 129 N MAIN ST, WAGENER, SC 29164
- **Practice address phone:** (803) 564-5381
- **Practice address fax:** (803) 564-5398
- **Mailing address:** PO BOX 129, WAGENER, SC 29164-0129
- **Mailing address phone:** (803) 564-5381
- **Mailing address fax:** (803) 564-5398

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 6210 | SC | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 06/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1001 | — | SC |
| 01 | — | 2088208 | PK | — |