Organization
LORIS DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS SINGLETON BAILEY (PRESIDENT)
(843) 756-4021
Entity
Organization
Contact information
Practice address
4125 MAIN ST, LORIS, SC 29569-3023
(843) 756-4021
(843) 756-9124
Mailing address
4125 MAIN ST, LORIS, SC 29569-3023
(843) 756-4021
(832) 756-9124
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
50001951
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0425371
—
NC
01
—
4214160
NCPDP
SC
05
—
615383
—
SC
05
—
719515
—
SC
Enumeration date
06/15/2005
Last updated
02/13/2008
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