Healthcare Provider Details

I. General information

NPI: 1275671851
Provider Name (Legal Business Name): BHP LAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 COLONIAL COMMONS CT
LANCASTER SC
29720-2215
US

IV. Provider business mailing address

1228 COLONIAL COMMONS CT
LANCASTER SC
29720-2215
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-8444
  • Fax: 803-286-8466
Mailing address:
  • Phone: 803-286-8444
  • Fax: 803-286-8466

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 Number17493
License Number StateSC

VIII. Authorized Official

Name: VIPUL PATEL
Title or Position: OWNER/AO
Credential:
Phone: 803-804-4735