=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275545667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR HEALTH AND WELL-BEING PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CENTER FOR HEALTH AND WELL-BEING PHARMACY 1401 DEVINE STREET
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29208-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-777-4890
-----------------------------------------------------
Fax | 803-777-0965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CENTER FOR HEALTH AND WELL-BEING PHARMACY 1401 DEVINE STREET
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29208-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-777-4890
-----------------------------------------------------
Fax | 803-777-0965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | WENDY RENE CHILES
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 803-777-4890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number | 50000829
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------