Basic Information
| Provider Information | |||||||||
| NPI: | 1831266592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HORIZON PHARMACY #2 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 PENDLETON ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296013209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647513200 | ||||||||
| FaxNumber: | 8647513218 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 PENDLETON ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296013209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647513200 | ||||||||
| FaxNumber: | 8647513218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | REGINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8642331534 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 50006758 | SC | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | BN8183939 | 01 | DEA | OTHER | 4224399 | 01 | NCPDP | OTHER | 767588 | 05 | SC | MEDICAID |