Healthcare Provider Details

I. General information

NPI: 1235576711
Provider Name (Legal Business Name): CHARLESTON ENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 N HIGHWAY 17 135
MT PLEASANT SC
29466-8227
US

IV. Provider business mailing address

2295 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7801
US

V. Phone/Fax

Practice location:
  • Phone: 843-654-7494
  • Fax:
Mailing address:
  • Phone: 843-793-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES VECCHIOLLA
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 843-793-6402