Healthcare Provider Details

I. General information

NPI: 1255182663
Provider Name (Legal Business Name): PARKVIEW COLUMBIA RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 CHARLESTON HWY
WEST COLUMBIA SC
29169-5050
US

IV. Provider business mailing address

3920 MAIN ST STE 100
AMHERST NY
14226-3350
US

V. Phone/Fax

Practice location:
  • Phone: 803-849-1777
  • Fax: 803-849-1776
Mailing address:
  • Phone: 716-876-2323
  • Fax: 716-876-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN WACLAWEK
Title or Position: COO
Credential:
Phone: 716-876-2323