Healthcare Provider Details

I. General information

NPI: 1114114501
Provider Name (Legal Business Name): TANDEM HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

IV. Provider business mailing address

PO BOX 250
SUMTER SC
29151-0250
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4579
  • Fax: 803-774-4643
Mailing address:
  • Phone: 803-774-4579
  • Fax: 803-774-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number9614
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANNIE BROWN
Title or Position: CEO
Credential:
Phone: 803-774-4500