Healthcare Provider Details

I. General information

NPI: 1598995367
Provider Name (Legal Business Name): CHILDRENS CARE #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST
DARLINGTON SC
29532-3953
US

IV. Provider business mailing address

203 S MAIN ST
DARLINGTON SC
29532-3953
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-6020
  • Fax: 943-395-2595
Mailing address:
  • Phone: 843-395-6020
  • Fax: 943-395-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4443
License Number StateSC

VIII. Authorized Official

Name: MR. TERRY T LEWIS
Title or Position: OWNER
Credential: RPH,CDM
Phone: 843-395-6020