Provider Demographics
NPI:1538199260
Name:COMMUNITY DRUG STORE, INC.
Entity type:Organization
Organization Name:COMMUNITY DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-295-0550
Mailing Address - Street 1:2956 NEW EASLEY HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-7132
Mailing Address - Country:US
Mailing Address - Phone:864-295-0550
Mailing Address - Fax:864-269-2358
Practice Address - Street 1:2956 NEW EASLEY HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7132
Practice Address - Country:US
Practice Address - Phone:864-295-0550
Practice Address - Fax:864-269-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI50006675OtherSTATE PERMIT NUMBER
SCAL0336330OtherDEA
RI50006675OtherSTATE PERMIT NUMBER