Organization
SPECIALTY PHARMACY MYRTLE BEACH LLC
Active
Other names
Specialty Pharmacy Myrtle Beach
Organization subpart
No
Provider details
NPI number
Authorized official
BILLY WEASE (OWNER)
(704) 913-7450
Entity
Organization
Contact information
Practice address
5900 N KINGS HWY STE C, MYRTLE BEACH, SC 29577-2326
(843) 712-1703
(843) 712-1705
Mailing address
5900 N KINGS HWY STE C, MYRTLE BEACH, SC 29577-2326
(843) 712-1703
(843) 712-1705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11125
SC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4229781
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/28/2010
Last updated
10/01/2010
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