=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376424440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL UNIVERSITY HOSPITAL AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 SAINT MATTHEWS RD
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29118-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-876-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 169 ASHLEY AVE RM 149
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29425-8905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-876-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE DIRECTOR
-----------------------------------------------------
Name | ERICKA A SOMMERS WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-792-7810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------