Healthcare Provider Details

I. General information

NPI: 1821337221
Provider Name (Legal Business Name): PAWLEYS ISLAND COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 OCEAN HWY UNIT 2
PAWLEYS ISLAND SC
29585-7585
US

IV. Provider business mailing address

9710 OCEAN HWY UNIT 2
PAWLEYS ISLAND SC
29585-7585
US

V. Phone/Fax

Practice location:
  • Phone: 843-235-3009
  • Fax:
Mailing address:
  • Phone: 843-235-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number14285
License Number StateSC

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. LEWIS DARWIN WALDREP
Title or Position: PARTNER/PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 843-235-3009