Organization
MEDICINE MART OF ORANGEBURG INC
Active
Other names
MEDICINE MART
Organization subpart
No
Provider details
NPI number
Authorized official
PAT WOOTEN RPH (OWNER)
(803) 531-3141
Entity
Organization
Contact information
Practice address
1291 BROUGHTON ST, ORANGEBURG, SC 29115-5967
(803) 531-3141
(803) 531-3143
Mailing address
PO BOX 1685, ORANGEBURG, SC 29116-1685
(803) 531-3141
(803) 531-3143
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
50009035
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4216075
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
723222
—
SC
05
—
790356
—
SC
Enumeration date
10/03/2006
Last updated
12/28/2010
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