Healthcare Provider Details

I. General information

NPI: 1548558216
Provider Name (Legal Business Name): WILLIAM C. ALDRICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 PROFESSIONAL CT
MANNING SC
29102-2827
US

IV. Provider business mailing address

1036 PROFESSIONAL CT
MANNING SC
29102-2827
US

V. Phone/Fax

Practice location:
  • Phone: 803-433-5220
  • Fax: 888-318-5567
Mailing address:
  • Phone: 803-433-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MYRA ERNA
Title or Position: PHARMACY MANAGER
Credential:
Phone: 803-433-5220