Healthcare Provider Details

I. General information

NPI: 1417382045
Provider Name (Legal Business Name): SIMPLICITY PHARMACY SERVICES,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ATRIUM WAY
COLUMBIA SC
29223-6301
US

IV. Provider business mailing address

110 ATRIUM WAY
COLUMBIA SC
29223-6301
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-8916
  • Fax: 803-865-9110
Mailing address:
  • Phone: 803-419-8916
  • Fax: 803-865-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number10006
License Number StateSC

VIII. Authorized Official

Name: SABRINA N RUSS
Title or Position: PRESIDENT/PHARMACIST
Credential: PHARM.D.
Phone: 803-419-8916