Healthcare Provider Details

I. General information

NPI: 1336206853
Provider Name (Legal Business Name): S.C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 FARROW RD BLDG 16
STATE PARK SC
29147
US

IV. Provider business mailing address

1751 CALHOUN ST PO BOX 101106
COLUMBIA SC
29201-2606
US

V. Phone/Fax

Practice location:
  • Phone: 803-896-6250
  • Fax: 803-896-6252
Mailing address:
  • Phone: 803-898-0813
  • Fax: 803-898-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50009033
License Number StateSC

VIII. Authorized Official

Name: MRS. CAROLINE Y SOJOURNER
Title or Position: DIRECTOR
Credential: RPH
Phone: 803-898-0813