Healthcare Provider Details

I. General information

NPI: 1033760483
Provider Name (Legal Business Name): EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 OLD EASTOVER RD
EASTOVER SC
29044-8303
US

IV. Provider business mailing address

3041 OLD EASTOVER RD
EASTOVER SC
29044-8303
US

V. Phone/Fax

Practice location:
  • Phone: 803-875-8010
  • Fax:
Mailing address:
  • Phone: 803-875-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DELGADO CANTAVE
Title or Position: CEO
Credential:
Phone: 803-733-5969