Organization
PROFESSIONAL PHARMACY OF MARION INC
Active
Other names
PROFESSIONAL PHCY OF MARION INC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS FULLER BS PHARMACT (VP)
(843) 423-1882
Entity
Organization
Contact information
Practice address
223 N MAIN ST, MARION, SC 29571-3025
(843) 423-1882
(843) 423-5006
Mailing address
PO BOX 1109, MARION, SC 29571-1109
(843) 422-1882
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2363
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4216443
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
723632
—
SC
Enumeration date
10/11/2006
Last updated
09/22/2011
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