Healthcare Provider Details

I. General information

NPI: 1972998128
Provider Name (Legal Business Name): WALHALLA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 04/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E MAIN ST
WALHALLA SC
29691-1927
US

IV. Provider business mailing address

21 DOWNS LOOP
CLEMSON SC
29631-2009
US

V. Phone/Fax

Practice location:
  • Phone: 864-916-0680
  • Fax:
Mailing address:
  • Phone: 864-916-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12069
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number12069
License Number StateSC

VIII. Authorized Official

Name: DR. YOUSSEF GEORGE ELAFFY
Title or Position: OWNER, PIC
Credential: PHARM-D, CGP
Phone: 864-916-0680