Organization
BRUNSON'S PHARMACY, LLC
Active
Other names
Brunson's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES V MATHIS JR. PHARMD (OWNER)
(803) 435-2511
Entity
Organization
Contact information
Practice address
12 N BROOKS ST, SUITE 206, MANNING, SC 29102-3206
(803) 435-2511
(803) 435-4235
Mailing address
PO BOX 1250, 12 N BROOKS ST, MANNING, SC 29102-1250
(803) 435-2511
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
14411
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4231217
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
714411
—
SC
Enumeration date
03/29/2013
Last updated
01/26/2021
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