MEDICARE: HAWTHORNE PHARMACY ON SUNSET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255521357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWTHORNE PHARMACY ON SUNSET

Provider Business Mailing Address
First Line	:	2854 SUNSET BLVD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3420
Country	:	US
Telephone Number	:	803-794-7990
Fax Number	:	803-739-0893

Provider Business Practice Location Address
First Line	:	2854 SUNSET BLVD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3420
Country	:	US
Telephone Number	:	803-794-7990
Fax Number	:	803-739-0893

Authorized Official
Title or Position	:	OWNER / PHARMACIST
Name	:	MR. JAMES ADDISON LIVINGSTON
Credential	:	PHARMD
Telephone Number	:	803-794-7990

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	02/18/2008

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