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General NPI Number Information
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NPI Number | 1255416616
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Entity Type | Organization
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Legal Business Name | PLANTATION PHARMACY AT ELLIS OAKS
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 776 DANIEL ELLIS DR 2C
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City | CHARLESTON
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State | SC
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Zip | 29412-3094
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Country | US
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Telephone | 843-795-9554
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Fax | 843-795-2660
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Provider Business Mailing Address
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Address Line | 776 DANIEL ELLIS DR 2C
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City | CHARLESTON
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State | SC
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Zip | 29412-3094
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Country | US
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Telephone | 843-795-9554
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Fax | 843-795-2660
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBORAH DAPORE
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Credential | R.PH.
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Telephone | 843-795-9554
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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 | 010727966
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License Number State | SC
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