Healthcare Provider Details

I. General information

NPI: 1700876927
Provider Name (Legal Business Name): PITT STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PITT ST
MT PLEASANT SC
29464-5318
US

IV. Provider business mailing address

111 PITT ST
MT PLEASANT SC
29464-5318
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-4051
  • Fax: 843-884-9117
Mailing address:
  • Phone: 843-884-4051
  • Fax: 843-884-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4978
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3596
License Number StateSC

VIII. Authorized Official

Name: MR. WALTER KIM RICHARDSON
Title or Position: OWNER / PRESIDENT / PHARMACIST
Credential: RPH
Phone: 843-884-4051