Healthcare Provider Details

I. General information

NPI: 1124341466
Provider Name (Legal Business Name): BOYD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SAM RITTENBERG BLVD SUITE 116B
CHARLESTON SC
29407-4629
US

IV. Provider business mailing address

2000 SAM RITTENBERG BLVD SUITE 116B
CHARLESTON SC
29407-4629
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-7633
  • Fax: 843-769-7693
Mailing address:
  • Phone: 843-769-7633
  • Fax: 843-769-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10812
License Number StateSC

VIII. Authorized Official

Name: DAVID GRIMM
Title or Position: CEO
Credential:
Phone: 843-769-7633