Healthcare Provider Details

I. General information

NPI: 1649250333
Provider Name (Legal Business Name): HEDGEMARK BRENTWOOD PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 ASHLEY RIVER ROAD
CHARLESTON SC
29407
US

IV. Provider business mailing address

1548 ASHLEY RIVER ROAD
CHARLESTON SC
29407
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-1177
  • Fax: 843-762-4506
Mailing address:
  • Phone: 843-762-1177
  • Fax: 843-762-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50-002227
License Number StateSC

VIII. Authorized Official

Name: MRS. ELLEN S. DURRENCE
Title or Position: V-PRESIDENT
Credential: R.PH.
Phone: 843-762-1177