Healthcare Provider Details

I. General information

NPI: 1275596249
Provider Name (Legal Business Name): DELTA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E MAIN ST
MONCKS CORNER SC
29461-3616
US

IV. Provider business mailing address

402 E MAIN ST
MONCKS CORNER SC
29461-3616
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-5255
  • Fax: 843-899-4970
Mailing address:
  • Phone: 843-761-5255
  • Fax: 843-899-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1991
License Number StateSC

VIII. Authorized Official

Name: SHERRY PARSONS
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-761-5255