=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033291513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH CAROLINA ONCOLOGY ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 06/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 STONERIDGE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-461-3709
-----------------------------------------------------
Fax | 803-461-3426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 STONERIDGE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-461-3709
-----------------------------------------------------
Fax | 803-461-3426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | DR. ERIC SOONG
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 803-461-3077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 7987
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------