Healthcare Provider Details

I. General information

NPI: 1881366433
Provider Name (Legal Business Name): VINCE BUTTRICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SUNSET BOULEVARD PHARMACY DEPARTMENT
WEST COLUMBIA SC
29169
US

IV. Provider business mailing address

527 BEVERLY DR
WEST COLUMBIA SC
29169-4589
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7767
  • Fax:
Mailing address:
  • Phone: 330-421-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number13910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: