Organization
MAAA LLC
Active
Other names
Indian Land Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONAK PATEL (OWNER)
(856) 472-2773
Entity
Organization
Contact information
Practice address
8437 CHARLOTTE HWY, INDIAN LAND, SC 29707-7587
(803) 228-0268
(803) 228-3580
Mailing address
8437 CHARLOTTE HWY, INDIAN LAND, SC 29707-7587
(803) 228-0268
(803) 228-3580
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
17465
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2171934
PK
—
05
—
717465
—
SC
Enumeration date
08/24/2017
Last updated
07/19/2018
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