| Organization Name: | MEDICINE MAN PHARMACY L.L.C. |
| NPI Number: | 1689868325 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL RICHARD MISSROON (PHARMACIST) |
| Mailing Address: | 404 Trolley Rd Summerville |
| State: | SC US |
| Postal Code: | 294855661 |
| Phone Number: | 8438716974 |
| Fax Number: | 8438519548 |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 09/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 333600000X |
| License Number: | 1568 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |