# MEDICINE CABINET OF LAKE CITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE MEDICINE CABINET
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306916481
- **Authorized official:** TERRY BLACKMON BS PHARMACY (PRESIDENT)
- **Authorized official phone:** (843) 374-2825

## Contact information

- **Practice address:** 319 MERCY ST, LAKE CITY, SC 29560-2331
- **Practice address phone:** (843) 374-2825
- **Practice address fax:** (843) 374-9914
- **Mailing address:** 319 MERCY ST, LAKE CITY, SC 29560-2331
- **Mailing address phone:** (843) 374-2825
- **Mailing address fax:** (843) 374-9914

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 14915 | SC | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 12/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2089116 | PK | — |
| 05 | — | 714915 | — | SC |