Provider Demographics
NPI:1487878484
Name:PROFESSIONAL PHARMACY AT MT. VIEW, INC
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY AT MT. VIEW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-877-4281
Mailing Address - Street 1:408 MEMORIAL DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1818
Mailing Address - Country:US
Mailing Address - Phone:864-877-4281
Mailing Address - Fax:864-877-4077
Practice Address - Street 1:408 MEMORIAL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1818
Practice Address - Country:US
Practice Address - Phone:864-877-4281
Practice Address - Fax:864-877-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1504332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC615043Medicaid