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General NPI Number Information
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NPI Number | 1457233207
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Entity Type | Organization
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Legal Business Name | MAR'NAE' ESSENTIALS LLC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 10765 HIGHWAY 78 E APT 312
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City | SUMMERVILLE
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State | SC
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Zip | 29483-8745
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Country | US
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Telephone | 843-303-0458
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 N MAIN ST # 1020
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7308
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Country | US
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Telephone | 843-303-0458
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMATHA MISHELL SIMPSON
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Credential |
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Telephone | 843-303-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 331L00000X
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Taxonomy Name | Blood Bank
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License Number |
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License Number State |
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