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General NPI Number Information
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NPI Number | 1255777017
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Entity Type | Organization
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Legal Business Name | STATE OF SOUTH CAROLINA
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 352 HALTON RD
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City | GREENVILLE
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State | SC
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Zip | 29607-3406
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Country | US
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Telephone | 864-372-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 BULL ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2104
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Country | US
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Telephone | 803-898-0813
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | CAROLINE SOJOURNER
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Credential | RPH
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Telephone | 803-898-0813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 14614
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License Number State | SC
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