Healthcare Provider Details

I. General information

NPI: 1881004570
Provider Name (Legal Business Name): HEALTH SERVICES OF THE LOWCOUNTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 RIVERWALK BLVD SUITE 1
RIDGELAND SC
29936-8190
US

IV. Provider business mailing address

149 RIVERWALK BLVD SUITE 1
RIDGELAND SC
29936-8190
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-9973
  • Fax: 843-645-9974
Mailing address:
  • Phone: 843-645-9973
  • Fax: 843-645-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15211
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number15211
License Number StateSC

VIII. Authorized Official

Name: DR. ANTHONY SMITH
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 843-645-9973