Healthcare Provider Details

I. General information

NPI: 1215348644
Provider Name (Legal Business Name): EXIGO PHARMACEUTICALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRUSHY CREEK RD
EASLEY SC
29642-1120
US

IV. Provider business mailing address

115 BRUSHY CREEK RD
EASLEY SC
29642-1120
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-1633
  • Fax: 864-855-1323
Mailing address:
  • Phone: 864-855-1633
  • Fax: 864-855-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. DANIEL A MCCOLLUM
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 864-855-1633