Healthcare Provider Details

I. General information

NPI: 1699194738
Provider Name (Legal Business Name): PHILLIP EADDY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 PROPRIETORS PL
MOUNT PLEASANT SC
29466-8361
US

IV. Provider business mailing address

3000 PROPRIETORS PL
MOUNT PLEASANT SC
29466-8361
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-2824
  • Fax: 843-884-2850
Mailing address:
  • Phone: 843-884-2824
  • Fax: 843-884-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8527
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: