Organization
UPSTATE PHARMACY IMA
Active
Other names
Upstate Pharmacy IMA
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN RANCK (MANAGER, PHARMACY)
(864) 455-1325
Entity
Organization
Contact information
Practice address
1025 VERDAE BLVD STE A, GREENVILLE, SC 29607-4032
(864) 286-7545
(864) 455-1350
Mailing address
1025 VERDAE BLVD, SUITE A, GREENVILLE, SC 29607-4032
(864) 286-7545
(864) 455-1350
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
14249
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4231015
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/25/2012
Last updated
10/25/2012
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