# MICA PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Airport Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215983952
- **Authorized official:** JOSEPH BLIZZARD (OWNER/PRESIDENT)
- **Authorized official phone:** (803) 755-9600

## Contact information

- **Practice address:** 3907 EDMUND HWY, WEST COLUMBIA, SC 29170-1944
- **Practice address phone:** (803) 755-9600
- **Practice address fax:** (803) 755-3271
- **Mailing address:** 3907 EDMUND HWY, WEST COLUMBIA, SC 29170-1944
- **Mailing address phone:** (803) 755-9600
- **Mailing address fax:** (803) 755-3271

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 15216 | SC | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 06/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2146051 | PK | — |
| 05 | — | 790937 | — | SC |