Healthcare Provider Details

I. General information

NPI: 1205972098
Provider Name (Legal Business Name): SAMUEL C HOGUE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 GARNERS FERRY RD
COLUMBIA SC
29209-2602
US

IV. Provider business mailing address

112 LAUREL CROSSING DR
LUGOFF SC
29078-9194
US

V. Phone/Fax

Practice location:
  • Phone: 803-695-1710
  • Fax:
Mailing address:
  • Phone: 803-438-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8415
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: