Provider Demographics
NPI:1104979350
Name:PARENTERAL LABS & NUTRITION, INC
Entity type:Organization
Organization Name:PARENTERAL LABS & NUTRITION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:864-220-9787
Mailing Address - Street 1:100B SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4413
Mailing Address - Country:US
Mailing Address - Phone:864-220-9787
Mailing Address - Fax:864-295-4419
Practice Address - Street 1:100B SIMPSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4413
Practice Address - Country:US
Practice Address - Phone:864-220-9787
Practice Address - Fax:864-295-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC558550332B00000X
SC725482332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0739950001Medicare NSC