Healthcare Provider Details

I. General information

NPI: 1376424440
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1442
US

IV. Provider business mailing address

169 ASHLEY AVE RM 149
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0199
  • Fax:
Mailing address:
  • Phone: 843-876-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERICKA A SOMMERS WILSON
Title or Position: CORPORATE DIRECTOR
Credential:
Phone: 843-792-7810