Healthcare Provider Details

I. General information

NPI: 1598849986
Provider Name (Legal Business Name): MOBILE MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 E SOUTH PLEASANTBURG DRIVE
GREENVILLE SC
29605
US

IV. Provider business mailing address

200 WEST 5TH STREET NORTH
SUMMERVILLE SC
29483
US

V. Phone/Fax

Practice location:
  • Phone: 864-569-0418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARY BESON II
Title or Position: OWNER
Credential:
Phone: 843-285-7903