Provider Demographics
NPI:1083111694
Name:GOOD PHARMACY INC
Entity type:Organization
Organization Name:GOOD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT SWEAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-327-2081
Mailing Address - Street 1:1237 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2353
Mailing Address - Country:US
Mailing Address - Phone:803-327-2081
Mailing Address - Fax:803-327-3585
Practice Address - Street 1:1237 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2353
Practice Address - Country:US
Practice Address - Phone:803-327-2081
Practice Address - Fax:803-327-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
SC3113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175228OtherPK