Healthcare Provider Details

I. General information

NPI: 1801480405
Provider Name (Legal Business Name): JOSEPH H. NEAL HEALTH COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 BARNWELL ST STE 1
COLUMBIA SC
29201-3567
US

IV. Provider business mailing address

1411 BARNWELL ST STE 1
COLUMBIA SC
29201-3567
US

V. Phone/Fax

Practice location:
  • Phone: 803-386-0475
  • Fax: 803-764-3005
Mailing address:
  • Phone: 803-849-8434
  • Fax: 803-764-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAY J PRYOR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 803-386-0475