Healthcare Provider Details

I. General information

NPI: 1780958744
Provider Name (Legal Business Name): DOGWOOD PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MILLER RD, SUITE K
GREENVILLE SC
29607-6541
US

IV. Provider business mailing address

3200 LAKE EMMA RD UNIT 1000
LAKE MARY FL
32746-3358
US

V. Phone/Fax

Practice location:
  • Phone: 866-840-4067
  • Fax: 866-514-8299
Mailing address:
  • Phone: 866-840-4067
  • Fax: 866-514-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13938
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS MAROULIS
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 689-263-5021