# VINCENTS DRUG STORE AND SODA FOUNTAIN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VINCENTS DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265515795
- **Authorized official:** SUSAN CAIN BS (PRESIDENT)
- **Authorized official phone:** (888) 479-2000

## Contact information

- **Practice address:** 110 PLANTED ROW LANE, JOHNS ISLAND, SC 29455
- **Practice address phone:** (843) 243-0007
- **Practice address fax:** (843) 243-0039
- **Mailing address:** 130 GARDNERS CIR \# 122, JOHNS ISLAND, SC 29455-5467
- **Mailing address phone:** (843) 243-0007
- **Mailing address fax:** (843) 243-0039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9712 | SC | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2092739 | PK | — |
| 05 | — | 782460 | — | SC |