Organization
ZIVITSKI HEALTH GROUP LLC
Active
Other names
Gray Court Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD ZIVITSKI (OWNER)
(864) 876-3837
Entity
Organization
Contact information
Practice address
345 W MAIN STREET, GRAY COURT, SC 29645
(864) 876-3837
(864) 876-1137
Mailing address
PO BOX 96, GRAY COURT, SC 29645-0096
(864) 876-3837
(864) 876-1137
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
17663
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177354
PK
—
05
—
711725
—
SC
Enumeration date
02/01/2018
Last updated
05/17/2018
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