Provider Demographics
NPI:1417251208
Name:PIGGLY WIGGLY MIDEAST INC
Entity type:Organization
Organization Name:PIGGLY WIGGLY MIDEAST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-554-9880
Mailing Address - Street 1:9092 OLD NUMBER SIX HWY
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142-8621
Mailing Address - Country:US
Mailing Address - Phone:843-554-9880
Mailing Address - Fax:
Practice Address - Street 1:9092 OLD NUMBER SIX HWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-8621
Practice Address - Country:US
Practice Address - Phone:843-554-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11472333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4230152OtherNCPDP PROVIDER IDENTIFICATION NUMBER