Healthcare Provider Details

I. General information

NPI: 1952699688
Provider Name (Legal Business Name): HOPE CLINIC
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

110 EXECUTIVE PKWY
MONCKS CORNER SC
29461-3930
US

IV. Provider business mailing address

110 EXECUTIVE PKWY
MONCKS CORNER SC
29461-3930
US

V. Phone/Fax

Practice location:
  • Phone: 843-725-1225
  • Fax: 888-318-5567
Mailing address:
  • Phone: 843-725-1225
  • Fax: 888-318-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TEMISAN ETIKEVENTSE
Title or Position: PHARMACY MANAGER
Credential:
Phone: 843-725-1225