Organization
BLACK RIVER GROCERY LLC
Active
Other names
SupRx Pharmacy #80, Andrews Rx
Organization subpart
No
Provider details
NPI number
Authorized official
TROY BLAKELY LAMB PHARMD (PIC)
(843) 264-3291
Entity
Organization
Contact information
Practice address
15 W ASHLAND ST, ANDREWS, SC 29510-2543
(843) 264-3291
(843) 264-5425
Mailing address
15 W ASHLAND ST, ANDREWS, SC 29510-2543
(843) 264-3291
(843) 264-5425
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
14725
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141517
PK
—
Enumeration date
12/29/2006
Last updated
10/31/2025
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