Healthcare Provider Details

I. General information

NPI: 1033223011
Provider Name (Legal Business Name): OKATIE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WILLIAM POPE DR STE 103
BLUFFTON SC
29909-7515
US

IV. Provider business mailing address

30 WILLIAM POPE DR STE 103
BLUFFTON SC
29909-7515
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-4444
  • Fax: 843-705-4445
Mailing address:
  • Phone: 843-705-4444
  • Fax: 843-705-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50005351
License Number StateSC

VIII. Authorized Official

Name: LOUIS SCAVO
Title or Position: OWNER
Credential: RPH
Phone: 843-705-4444