Healthcare Provider Details

I. General information

NPI: 1962189332
Provider Name (Legal Business Name): CHELSEA GENTRY BOOHER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 FOLLY RD
CHARLESTON SC
29412-3919
US

IV. Provider business mailing address

550 HARBOR COVE LN APT 2000D
CHARLESTON SC
29412-3016
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-5452
  • Fax:
Mailing address:
  • Phone: 865-500-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43927
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: