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General NPI Number Information
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NPI Number | 1225394760
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Entity Type | Organization
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Legal Business Name | BEAUFORT PHARMACY AND COMPOUNDING LLC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 810 ELM ST E
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City | HAMPTON
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State | SC
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Zip | 29924-2610
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Country | US
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Telephone | 803-914-0318
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Fax | 803-914-0311
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Provider Business Mailing Address
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Address Line | 810 ELM ST E
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City | HAMPTON
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State | SC
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Zip | 29924-2610
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Country | US
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Telephone | 803-914-0318
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Fax | 803-914-0311
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY SIMMONS
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Credential | PHARMD
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Telephone | 843-729-5583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 15492
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License Number State | SC
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