Provider Demographics
NPI:1962433052
Name:PEOPLES DRUG CO LLC
Entity type:Organization
Organization Name:PEOPLES DRUG CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-445-2300
Mailing Address - Street 1:301 W BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138
Mailing Address - Country:US
Mailing Address - Phone:864-445-2300
Mailing Address - Fax:864-445-2300
Practice Address - Street 1:301 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138
Practice Address - Country:US
Practice Address - Phone:864-445-2300
Practice Address - Fax:864-445-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50002459333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC724591Medicaid
SC724591Medicaid
0658930001Medicare ID - Type Unspecified