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General NPI Number Information
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NPI Number | 1467600296
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETRANS AFFAIRS
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 109 BEE ST 3625 RIVERS AVE SUITE2
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 843-745-8637
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Fax | 843-747-6841
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Provider Business Mailing Address
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Address Line | 5600 DORCHESTER RD APT 1406 POBOX 70103
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City | CHARLESTON
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State | SC
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Zip | 29418-5517
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Country | US
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Telephone | 843-864-9124
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Fax | 843-747-6841
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Authorized Official
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Title or Position | PHARAMICST
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Name | MR. JAMES HOPKINS
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Credential | SUPERVISOR
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Telephone | 843-745-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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