Healthcare Provider Details

I. General information

NPI: 1477614451
Provider Name (Legal Business Name): DONALD EDWARD DELAND CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

136 THOUSAND OAKS CIR
GOOSE CREEK SC
29445-7263
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-5952
  • Fax: 843-792-5582
Mailing address:
  • Phone: 843-863-8683
  • Fax: 843-792-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14421
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: