Healthcare Provider Details

I. General information

NPI: 1821172941
Provider Name (Legal Business Name): SOUTH CAROLINA ERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S MAIN ST
SAN ANGELO TX
76903-5927
US

IV. Provider business mailing address

2 S MAIN ST
SAN ANGELO TX
76903-5927
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-6551
  • Fax: 325-655-7218
Mailing address:
  • Phone: 325-658-6551
  • Fax: 325-655-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20355
License Number StateTX

VIII. Authorized Official

Name: MRS. LINDA JOYCE ROE
Title or Position: DIRECTOR
Credential: RPH
Phone: 325-658-6551