Healthcare Provider Details

I. General information

NPI: 1295445419
Provider Name (Legal Business Name): LOWCOUNTRY LACTATION STATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 CHURCH CREEK DR
CHARLESTON SC
29414-6401
US

IV. Provider business mailing address

2076 CHURCH CREEK DR
CHARLESTON SC
29414-6401
US

V. Phone/Fax

Practice location:
  • Phone: 843-532-6310
  • Fax: 843-998-7643
Mailing address:
  • Phone: 843-532-6310
  • Fax: 843-998-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: LINDA E MERLI
Title or Position: SOLE MBR
Credential: RN, IBCLC
Phone: 843-532-6310