Loris Drug Store, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5001951 Issued in SC

Legal business name

LORIS DRUG STORE, INC.

Practice address

4125 Main St
Loris, SC 29569-3023

Phone

(843) 756-4021

Fax

(843) 756-9124

NPI assigned

Feb 14, 2007

Last updated

Feb 14, 2008By 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

Douglas Singleton Bailey

Title

President

Phone

(843) 756-4021

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1952444556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4125 MAIN ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295693023",
            "telephone_number": "843-756-4021",
            "fax_number": "843-756-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 MAIN ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295693023",
            "telephone_number": "843-756-4021",
            "fax_number": "843-756-9124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORIS DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "SINGLETON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-756-4021"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "5001951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "615383",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loris Community Hospital District (Loris Family Health Center)
• Loris Community Hospital District (DBA Southern Medical Associates)
• Loris Community Hospital District (Loris Healthcare System)
• Loris Drug Company LLC (Loris Drug Store)
• Loris Drug Store, Inc.
• Loris Eye Associates PC
• Loris Family Dentistry, LLC
• Loris Medical Center, PA
• Loris Physician Services
• Loris Rehab and Nursing Center, LLC

• Durable Medical Equipment & Medical Supplies in Loris, SC
• Providers in Loris, 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 Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.