Healthcare Provider Details

I. General information

NPI: 1215338058
Provider Name (Legal Business Name): TRUST CONCIERGE PHARMACEUTICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 CAROLINA FOREST BLVD STE 13
MYRTLE BEACH SC
29579-3587
US

IV. Provider business mailing address

4999 CAROLINA FOREST BLVD SUITE 13
MYRTLE BEACH SC
29579-3587
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-7733
  • Fax: 843-236-5805
Mailing address:
  • Phone: 843-236-7733
  • Fax: 843-236-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15507
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2147859
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: SAMER MARCOS
Title or Position: RPH/OWNER
Credential:
Phone: 843-222-5691