Healthcare Provider Details

I. General information

NPI: 1427393024
Provider Name (Legal Business Name): BLACKVILLE HEALTH INVESTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19354 SOLOMON BLATT AVE N
BLACKVILLE SC
29817-2304
US

IV. Provider business mailing address

PO BOX 310
GASTON SC
29053-0310
US

V. Phone/Fax

Practice location:
  • Phone: 803-284-3372
  • Fax: 803-284-3372
Mailing address:
  • Phone: 803-939-8489
  • Fax: 803-939-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KYLE FRANKLIN MCHUGH
Title or Position: PRESIDENT
Credential: RPH
Phone: 803-939-8489