Healthcare Provider Details

I. General information

NPI: 1477542694
Provider Name (Legal Business Name): CYPRESS CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL STREET
MANNING SC
29102-0550
US

IV. Provider business mailing address

50 HOSPITAL STREET
MANNING SC
29102-0550
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-5224
  • Fax:
Mailing address:
  • Phone: 803-435-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50005730
License Number StateSC

VIII. Authorized Official

Name: RENAE K. CHADWICK
Title or Position: SUPERVISOR
Credential: RPH
Phone: 803-435-5224