Healthcare Provider Details

I. General information

NPI: 1528395944
Provider Name (Legal Business Name): DELTA OF DANIEL ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ISLAND PARK DR STE 103
DANIEL ISLAND SC
29492-8019
US

IV. Provider business mailing address

402 E MAIN ST
MONCKS CORNER SC
29461-3616
US

V. Phone/Fax

Practice location:
  • Phone: 843-471-2870
  • Fax: 800-456-2788
Mailing address:
  • Phone: 843-761-5255
  • Fax: 843-899-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10680
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2122631
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: SHERRY PARSONS
Title or Position: MANGER
Credential:
Phone: 843-761-5255