Healthcare Provider Details

I. General information

NPI: 1245754746
Provider Name (Legal Business Name): L. DEXTER TRUAX SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ROBERT SMALLS PKWY
BEAUFORT SC
29906-4284
US

IV. Provider business mailing address

PO BOX 1018
HARDEEVILLE SC
29927-1018
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-8221
  • Fax:
Mailing address:
  • Phone: 912-777-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH5863
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH5863
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRPH017183
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH5863
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberRPH017183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: