Healthcare Provider Details

I. General information

NPI: 1013024967
Provider Name (Legal Business Name): ERICA HANESWORTH PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST # 119
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

4017 STOCKBRIDGE DR
CHARLESTON SC
29414-7538
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-6473
  • Fax: 843-805-5798
Mailing address:
  • Phone: 843-556-2898
  • Fax: 843-805-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9448
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: