Healthcare Provider Details

I. General information

NPI: 1902005135
Provider Name (Legal Business Name): S.C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CHEVES ST
FLORENCE SC
29506-2526
US

IV. Provider business mailing address

1751 CALHOUN ST PO BOX 101106
COLUMBIA SC
29201-2606
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-4830
  • Fax: 843-661-4859
Mailing address:
  • Phone: 803-898-0813
  • Fax: 803-898-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50009578
License Number StateSC

VIII. Authorized Official

Name: MRS. CAROLINE Y SOJOURNER
Title or Position: DIRECTOR
Credential: RPH
Phone: 803-898-0813