Healthcare Provider Details

I. General information

NPI: 1164341202
Provider Name (Legal Business Name): ETHAN WARREN EILO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

835 HALE ST
CHARLESTON SC
29412-3564
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9300
  • Fax: 843-792-1445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number60736
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: