Healthcare Provider Details

I. General information

NPI: 1780319293
Provider Name (Legal Business Name): HOME MEDIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 SUNSET BLVD
WEST COLUMBIA SC
29169-5914
US

IV. Provider business mailing address

1302 SUNSET BLVD
WEST COLUMBIA SC
29169-5914
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-7043
  • Fax: 803-796-1519
Mailing address:
  • Phone: 803-791-7043
  • Fax: 803-796-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNN ELTON CONNELLY
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: PHARMD
Phone: 803-791-7043