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General NPI Number Information
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NPI Number | 1295166742
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Entity Type | Organization
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Legal Business Name | PALMETTO SPECIALTY PHARMACY
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 172 MCSWAIN DR STE C
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4804
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Country | US
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Telephone | 803-724-1501
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Fax | 855-286-1676
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Provider Business Mailing Address
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Address Line | 172 MCSWAIN DR SUITE C
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4804
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Country | US
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Telephone | 803-724-1501
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Fax | 855-286-1676
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | CONNIE HARTLEY
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Credential |
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Telephone | 803-227-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 14939
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License Number State | SC
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