Healthcare Provider Details

I. General information

NPI: 1457971541
Provider Name (Legal Business Name): NEPHRON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 12TH STREET EXT STE B
WEST COLUMBIA SC
29172-3025
US

IV. Provider business mailing address

4500 12TH STREET EXT
WEST COLUMBIA SC
29172-3025
US

V. Phone/Fax

Practice location:
  • Phone: 803-569-2800
  • Fax: 803-296-0674
Mailing address:
  • Phone: 803-569-2812
  • Fax: 803-296-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM YTTRE
Title or Position: VP OF FINANCE
Credential:
Phone: 803-569-2800