Provider Demographics
NPI:1962554592
Name:SOUTH CAROLINA ERICA, INC
Entity type:Organization
Organization Name:SOUTH CAROLINA ERICA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, RX SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:325-658-6551
Mailing Address - Street 1:1926 N BRYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-3744
Mailing Address - Country:US
Mailing Address - Phone:325-653-3271
Mailing Address - Fax:325-653-3272
Practice Address - Street 1:1926 N BRYANT BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-3744
Practice Address - Country:US
Practice Address - Phone:325-653-3271
Practice Address - Fax:325-653-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144961Medicaid