Healthcare Provider Details

I. General information

NPI: 1780788430
Provider Name (Legal Business Name): EAU CLAIRE COOPERATIVE HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

IV. Provider business mailing address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

V. Phone/Fax

Practice location:
  • Phone: 803-252-3770
  • Fax: 803-252-7443
Mailing address:
  • Phone: 803-252-3770
  • Fax: 803-252-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. STUART HAMILTON
Title or Position: CEO
Credential:
Phone: 803-252-3770