Provider Demographics
NPI:1902430267
Name:SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
Entity Type:Organization
Organization Name:SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
Other - Org Name:SRHS PHARMACY - PELHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MGR - RETAIL PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILCORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:864-560-9212
Mailing Address - Street 1:100 E WOOD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3001
Mailing Address - Country:US
Mailing Address - Phone:864-560-9212
Mailing Address - Fax:
Practice Address - Street 1:2759 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4926
Practice Address - Country:US
Practice Address - Phone:864-530-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19339OtherSOUTH CAROLINA BOARD OF PHARMACY
SC7Z1072Medicaid