Healthcare Provider Details

I. General information

NPI: 1497184667
Provider Name (Legal Business Name): CHARLESTON ENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WINGO WAY SUITE 103
MT PLEASANT SC
29464-1810
US

IV. Provider business mailing address

2295 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7801
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-8774
  • Fax:
Mailing address:
  • Phone: 843-793-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number22628
License Number StateSC

VIII. Authorized Official

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