Healthcare Provider Details

I. General information

NPI: 1215180591
Provider Name (Legal Business Name): SANDHILLS MEDICAL FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N SALEM AVE
SUMTER SC
29150-4115
US

IV. Provider business mailing address

425 N SALEM AVE
SUMTER SC
29150-4115
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-8148
  • Fax: 803-775-5849
Mailing address:
  • Phone: 803-773-8148
  • Fax: 803-775-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10149
License Number StateSC

VIII. Authorized Official

Name: ALYSSA NORWOOD
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 803-438-5537