Healthcare Provider Details

I. General information

NPI: 1750527834
Provider Name (Legal Business Name): PINE RIDGE INVESTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 A PINE RIDGE DR
WEST COLUMBIA SC
29172
US

IV. Provider business mailing address

PO BOX 310
GASTON SC
29053-0310
US

V. Phone/Fax

Practice location:
  • Phone: 803-955-3404
  • Fax: 803-955-3406
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50010273
License Number StateSC

VIII. Authorized Official

Name: KYLE MCHUGH
Title or Position: PRESIDENT
Credential:
Phone: 803-939-8489