Organization
IRMO FAMILY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP D MIMS (PRESIDENT)
(803) 917-3627
Entity
Organization
Contact information
Practice address
7001 ST ANDREWS RD, A-16, COLUMBIA, SC 29212
(803) 749-9988
(803) 749-9096
Mailing address
7001 ST ANDREWS RD, A-16, COLUMBIA, SC 29212
(803) 749-9988
(803) 749-9096
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
50007248
SC
333600000X
Pharmacy
Primary
50009341
SC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4224870
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
772483
—
SC
Enumeration date
10/12/2006
Last updated
03/21/2008
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