Healthcare Provider Details

I. General information

NPI: 1538547682
Provider Name (Legal Business Name): MICHAEL CORVINO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2015
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

IV. Provider business mailing address

1949 CLAY LN
CHARLESTON SC
29414-6680
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-5655
  • Fax:
Mailing address:
  • Phone: 843-870-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number36021
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36021
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: