Organization
IVA DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANCE P BOLES RPH (PRESIDENT)
(864) 348-6138
Entity
Organization
Contact information
Practice address
720 E FRONT ST, IVA, SC 29655-9089
(864) 348-6138
(864) 348-2220
Mailing address
720 EAST FRONT STREET, P.O. BOX 26, IVA, SC 29655
(864) 348-6138
(864) 348-2220
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
50008094
SC
3336C0003X
Community/Retail Pharmacy
Primary
50008094
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
741128
—
SC
Enumeration date
06/14/2005
Last updated
05/13/2008
Update your record
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