Healthcare Provider Details

I. General information

NPI: 1962937318
Provider Name (Legal Business Name): HOLLY BALCER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2763
  • Fax:
Mailing address:
  • Phone: 843-724-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number011949
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: