Healthcare Provider Details

I. General information

NPI: 1942241880
Provider Name (Legal Business Name): SC HOME RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/07/2023
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 LEAPHART RD STE A
WEST COLUMBIA SC
29169-3067
US

IV. Provider business mailing address

3685 LEAPHART RD STE A
WEST COLUMBIA SC
29169-3067
US

V. Phone/Fax

Practice location:
  • Phone: 803-454-0194
  • Fax: 803-451-7128
Mailing address:
  • Phone: 803-454-0194
  • Fax: 803-451-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number50007457
License Number StateSC

VIII. Authorized Official

Name: CATHY SUE DAVIS
Title or Position: CPHT BILLING SPECIALIST
Credential:
Phone: 803-739-4278