Healthcare Provider Details

I. General information

NPI: 1639276561
Provider Name (Legal Business Name): PALMETTO STATE PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SAM RITTENBERG BLVD SUITE 116
CHARLESTON SC
29407-4629
US

IV. Provider business mailing address

2000 SAM RITTENBERG BLVD
CHARLESTON SC
29407-4629
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-7633
  • Fax: 843-769-7693
Mailing address:
  • Phone: 843-769-7633
  • Fax: 843-769-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number8831
License Number StateSC

VIII. Authorized Official

Name: NIKKEE FINLEY
Title or Position: PRIMARY RX
Credential:
Phone: 843-769-7633