Provider Demographics
NPI:1831060078
Name:MBD PHARMACY
Entity type:Organization
Organization Name:MBD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-692-9494
Mailing Address - Street 1:6507 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-3010
Mailing Address - Country:US
Mailing Address - Phone:843-692-9494
Mailing Address - Fax:843-692-7474
Practice Address - Street 1:6507 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-3010
Practice Address - Country:US
Practice Address - Phone:843-692-9494
Practice Address - Fax:843-692-7474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYRTLE BEACH DIET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty