Healthcare Provider Details

I. General information

NPI: 1538217401
Provider Name (Legal Business Name): CHILDREN'S CARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MCCLURE COURT
FLORENCE SC
29505
US

IV. Provider business mailing address

1530 MCCLURE COURT
FLORENCE SC
29505
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-1881
  • Fax: 843-679-1887
Mailing address:
  • Phone: 843-679-1881
  • Fax: 843-679-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDE2870
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50008779
License Number StateSC

VIII. Authorized Official

Name: MR. TERRY T LEWIS
Title or Position: PHARMACIST, CEO
Credential: RPH
Phone: 843-679-1881