Healthcare Provider Details

I. General information

NPI: 1740438647
Provider Name (Legal Business Name): EUTAWVILLE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 PORCHER AVE
EUTAWVILLE SC
29048-8557
US

IV. Provider business mailing address

402 E MAIN ST
MONCKS CORNER SC
29461-3616
US

V. Phone/Fax

Practice location:
  • Phone: 803-492-9201
  • Fax: 843-899-4970
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 Number10116
License Number StateSC

VIII. Authorized Official

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