Fairfax Pharmacy Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

50005433 Issued in SC

Legal business name

FAIRFAX PHARMACY INC.

Practice address

1275 Allendale Fairfax Hwy
Fairfax, SC 29827-9124

Phone

(803) 632-2055

Fax

(803) 632-1708

NPI assigned

Dec 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carol B. Davis

Title

President

Phone

(803) 632-2055

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Fairfax Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fairfax Pharmacy Inc.

  • Community/Retail Pharmacy
  • Fairfax, SC
  • NPI 1942250816
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790848976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298270366",
            "telephone_number": "803-632-2055",
            "fax_number": "803-632-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 ALLENDALE FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298279124",
            "telephone_number": "803-632-2055",
            "fax_number": "803-632-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-632-2055"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "50005433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE1145",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delois Daniels, APRN
• Cindy Davis, R.N.
• Lisa Davis, DNP, APRN, FNP-C
• Dva Healthcare Renal Care Inc (Allendale County Dialysis)
• Vivien Rose Ebert, DMD
• Fairfax Pharmacy Inc.
• Jerlesa Frazier-Harney, RN
• Christopher Michael Gamboa, MD
• Lewis Edward Gore III, PT, DPT
• Robert M Haberkorn, DDS,MBA

• Durable Medical Equipment & Medical Supplies in Fairfax, SC
• Providers in Fairfax, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.