Provider Demographics
NPI:1104237924
Name:PARKWAY DISCOUNT PHARMACY
Entity type:Organization
Organization Name:PARKWAY DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:SIKIRU
Authorized Official - Last Name:ODEDIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:843-399-9800
Mailing Address - Street 1:2126 HIGHWAY 9 E
Mailing Address - Street 2:BLDG D SUITE 9
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-5725
Mailing Address - Country:US
Mailing Address - Phone:843-399-9800
Mailing Address - Fax:
Practice Address - Street 1:2126 HIGHWAY 9 E
Practice Address - Street 2:BLDG D SUITE 9
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-5725
Practice Address - Country:US
Practice Address - Phone:843-399-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152123336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy