Provider Demographics
NPI:1063595171
Name:DANIEL'S PHARMACY # 3 INC
Entity type:Organization
Organization Name:DANIEL'S PHARMACY # 3 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:REG PHARMACIST
Authorized Official - Phone:803-259-1234
Mailing Address - Street 1:178 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-0178
Mailing Address - Country:US
Mailing Address - Phone:803-259-1234
Mailing Address - Fax:803-259-1239
Practice Address - Street 1:178 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1527
Practice Address - Country:US
Practice Address - Phone:803-259-1234
Practice Address - Fax:803-259-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50002818332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5000-2818OtherPHARMACY PERMIT #
SC728188Medicaid
SC42-18269OtherNABP
SCDME644Medicaid
SCDME644Medicaid