Healthcare Provider Details

I. General information

NPI: 1881797900
Provider Name (Legal Business Name): CHUCKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 HOLLY ST
HOLLY HILL SC
29059
US

IV. Provider business mailing address

PO BOX 370
HOLLY HILL SC
29059-0370
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-0007
  • Fax: 803-496-0015
Mailing address:
  • Phone: 803-496-0007
  • Fax: 803-496-0015

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 Number7564
License Number StateSC

VIII. Authorized Official

Name: RACHEL OSTEEN
Title or Position: PIC
Credential: RPH
Phone: 803-496-0007