Basic Information
| Provider Information | |||||||||
| NPI: | 1912016593 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOBLEY DRUGS, INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1073 W MEETING ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297202205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032852021 | ||||||||
| FaxNumber: | 8032857990 | ||||||||
| Practice Location | |||||||||
| Address1: | 1073 W MEETING ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297202205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032855555 | ||||||||
| FaxNumber: | 8032857990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOBLEY | ||||||||
| AuthorizedOfficialFirstName: | HUBERT | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8032852021 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | R.PH | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 50-001658 | SC | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 333600000X | 50-001658 | SC | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 716580 | 05 | SC | MEDICAID | 4211986 | 01 | SC | NCPDP BILLING | OTHER |