Healthcare Provider Details

I. General information

NPI: 1730669789
Provider Name (Legal Business Name): EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 OLD EASTOVER ROAD
EASTOVER SC
29044
US

IV. Provider business mailing address

169 LAURELHURST AVE
COLUMBIA SC
29210-3825
US

V. Phone/Fax

Practice location:
  • Phone: 803-875-8010
  • Fax: 803-875-8018
Mailing address:
  • Phone: 803-733-5969
  • 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