Provider Demographics
NPI:1386785996
Name:PEE DEE PHARMACY INC
Entity type:Organization
Organization Name:PEE DEE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:JR
Authorized Official - Credentials:R PH
Authorized Official - Phone:843-669-6389
Mailing Address - Street 1:136 OAK ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-2627
Mailing Address - Country:US
Mailing Address - Phone:843-393-0507
Mailing Address - Fax:
Practice Address - Street 1:123 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2533
Practice Address - Country:US
Practice Address - Phone:843-669-6389
Practice Address - Fax:843-662-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC729695Medicaid