# UPSTATE PHARMACY IMA

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

## Provider details

- **NPI number:** 1730432964
- **Authorized official:** STEVEN RANCK (MANAGER, PHARMACY)
- **Authorized official phone:** (864) 455-1325

## Contact information

- **Practice address:** 1025 VERDAE BLVD STE A, GREENVILLE, SC 29607-4032
- **Practice address phone:** (864) 286-7545
- **Practice address fax:** (864) 455-1350
- **Mailing address:** 1025 VERDAE BLVD, SUITE A, GREENVILLE, SC 29607-4032
- **Mailing address phone:** (864) 286-7545
- **Mailing address fax:** (864) 455-1350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 14249 | SC | Yes |

## Other

- **Enumeration date:** 10/25/2012
- **Last updated:** 10/25/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4231015 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |