Healthcare Provider Details

I. General information

NPI: 1831157726
Provider Name (Legal Business Name): PREFERRED CARE PHARMACEUTICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4794-A HIGHWAY 162
HOLLYWOOD SC
29449
US

IV. Provider business mailing address

4794-A HIGHWAY 162
HOLLYWOOD SC
29449
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-6522
  • Fax: 843-769-5728
Mailing address:
  • Phone: 843-769-6522
  • Fax: 843-769-5728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number50005902
License Number StateSC

VIII. Authorized Official

Name: MRS. MARY DIANE KEISLER
Title or Position: PRESIDENT
Credential: RPH
Phone: 843-769-6522