Provider Demographics
NPI:1548275142
Name:PIGGLY WIGGLY OF MANNING INC.
Entity type:Organization
Organization Name:PIGGLY WIGGLY OF MANNING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-773-6378
Mailing Address - Street 1:36 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2927
Mailing Address - Country:US
Mailing Address - Phone:803-433-2412
Mailing Address - Fax:803-433-8202
Practice Address - Street 1:36 SUNSET DR
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2927
Practice Address - Country:US
Practice Address - Phone:803-433-2412
Practice Address - Fax:803-433-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC500009463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2089725OtherPK
SC709460Medicaid