Healthcare Provider Details

I. General information

NPI: 1669889374
Provider Name (Legal Business Name): SWEETGRASS PHARMACY & COMPOUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 LONG GROVE DR STE 5
MT PLEASANT SC
29464-7579
US

IV. Provider business mailing address

1952 LONG GROVE DR STE 5
MT PLEASANT SC
29464-7579
US

V. Phone/Fax

Practice location:
  • Phone: 843-696-9103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11842
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number11842
License Number StateSC

VIII. Authorized Official

Name: DR. CYNTHIA REICH
Title or Position: CO-OWNER
Credential: PHARMD
Phone: 843-696-9103