Provider Demographics
NPI:1528079175
Name:CROMER MEDICAL SERVICES INC
Entity type:Organization
Organization Name:CROMER MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-276-0990
Mailing Address - Street 1:1310 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3048
Mailing Address - Country:US
Mailing Address - Phone:803-276-0990
Mailing Address - Fax:803-276-4276
Practice Address - Street 1:1310 WILSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3048
Practice Address - Country:US
Practice Address - Phone:803-276-0990
Practice Address - Fax:803-276-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC52893336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC752895Medicaid
2091708OtherPK
0258710001Medicare NSC