Organization
SOUTH CHURCH HEALTH MART PHARMACY LLC
Active
Other names
SOUTH CHURCH HEALTH MART PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DIANDRA BROOKS PHRMD (MANAGING MEMBER)
(864) 641-5351
Entity
Organization
Contact information
Practice address
550 S CHURCH ST, UNIT #9, SPARTANBURG, SC 29306-3306
(864) 596-4501
(864) 596-4503
Mailing address
550 S CHURCH ST, UNIT #9, SPARTANBURG, SC 29306-3306
(864) 596-4501
(864) 596-4503
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10246
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4227751
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/13/2008
Last updated
12/16/2009
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