# PONTIAC PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962691592
- **Authorized official:** BRIAN DUFFIE (PHCY MANG)
- **Authorized official phone:** (803) 865-0099

## Contact information

- **Practice address:** 10535 A TWO NOTCH RD, ELGIN, SC 29045
- **Practice address phone:** (803) 865-0099
- **Practice address fax:** (803) 865-0098
- **Mailing address:** 10535 A TWO NOTCH RD, ELGIN, SC 29045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 50009706 | SC | Yes |

## Other

- **Enumeration date:** 10/19/2007
- **Last updated:** 11/14/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4227422 | OTHER ID NUMBER | — |