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Organization

BLACKS DRUG STORE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT KEELS WYLIE RPH (PRESIDENT)
(803) 581-2102
Entity
Organization

Contact information

Practice address
121 CHURCH ST, CHESTER, SC 29706-2903
(803) 581-2102
(803) 581-2121
Mailing address
121 CHURCH ST, CHESTER, SC 29706-2903
(803) 581-2102
(803) 581-2121

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
600807
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
600807
SC
Enumeration date
09/18/2007
Last updated
09/18/2007
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