Organization
WAGENER DRUG CO INC
Active
Other names
WAGENER DRUG CO
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA DYCHES (OWNER)
(803) 564-5381
Entity
Organization
Contact information
Practice address
129 N MAIN ST, WAGENER, SC 29164
(803) 564-5381
(803) 564-5398
Mailing address
PO BOX 129, WAGENER, SC 29164-0129
(803) 564-5381
(803) 564-5398
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
6210
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001
—
SC
01
—
2088208
PK
—
Enumeration date
02/13/2007
Last updated
06/25/2013
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