MEDICARE: STRIDE PHARMACY

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1356982698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDE PHARMACY

Provider Business Mailing Address
First Line	:	1730 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2410
Country	:	US
Telephone Number	:	803-256-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 W MONTAGUE AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-5938
Country	:	US
Telephone Number	:	803-256-6776
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN L RAY
Credential	:	DPM
Telephone Number	:	803-256-6776

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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Directions to “STRIDE PHARMACY ” Practice Location

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