Healthcare Provider Details

I. General information

NPI: 1265152052
Provider Name (Legal Business Name): ANOOP KOTIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE FL 1
CHARLESTON SC
29425-8903
US

IV. Provider business mailing address

135 RUTLEDGE AVE FL 1
CHARLESTON SC
29425-8903
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43650
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: