Organization
MICA PHARMACY LLC
Active
Other names
Airport Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BLIZZARD (OWNER/PRESIDENT)
(803) 755-9600
Entity
Organization
Contact information
Practice address
3907 EDMUND HWY, WEST COLUMBIA, SC 29170-1944
(803) 755-9600
(803) 755-3271
Mailing address
3907 EDMUND HWY, WEST COLUMBIA, SC 29170-1944
(803) 755-9600
(803) 755-3271
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
15216
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146051
PK
—
05
—
790937
—
SC
Enumeration date
05/25/2006
Last updated
06/07/2016
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