Healthcare Provider Details

I. General information

NPI: 1295840148
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ELLIS OAK DR RM 119
CHARLESTON SC
29412-3089
US

IV. Provider business mailing address

650 ELLIS OAK DR RM 119
CHARLESTON SC
29412-3089
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-2969
  • Fax: 843-876-2967
Mailing address:
  • Phone: 843-876-2969
  • Fax: 843-876-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number863
License Number StateSC

VIII. Authorized Official

Name: THOMAS CRAWFORD
Title or Position: COO
Credential:
Phone: 843-792-8775