Provider Demographics
NPI:1053614958
Name:NYE'S PHARMACY OF CONWAY,INC.
Entity type:Organization
Organization Name:NYE'S PHARMACY OF CONWAY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:H
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:843-248-5015
Mailing Address - Street 1:1600 TENTH AVE.
Mailing Address - Street 2:NYE'S PHARMACY OF CONWAY,INC.
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526
Mailing Address - Country:US
Mailing Address - Phone:843-248-5015
Mailing Address - Fax:843-488-1942
Practice Address - Street 1:1600 10TH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4112
Practice Address - Country:US
Practice Address - Phone:843-248-5015
Practice Address - Fax:843-488-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies