Provider Demographics
NPI:1033131602
Name:STROM'S DRUG STORE #2
Entity type:Organization
Organization Name:STROM'S DRUG STORE #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:NORBERT
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-968-7000
Mailing Address - Street 1:124 SOUTH MAIN STREET
Mailing Address - Street 2:P.O. BOX 1838
Mailing Address - City:MC CORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835
Mailing Address - Country:US
Mailing Address - Phone:864-465-2011
Mailing Address - Fax:864-465-3150
Practice Address - Street 1:124 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:864-465-2011
Practice Address - Fax:864-465-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC799972Medicaid
4205577OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4205577OtherNCDDP
SC710880Medicaid