=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740652445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALMETTO HEALTH AND MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2015
-----------------------------------------------------
Last Update Date | 10/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 343 WHISPERING BREEZE LN
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29486-8276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-419-8642
-----------------------------------------------------
Fax | 843-419-8697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 343 WHISPERING BREEZE LN
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29486-8276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST, CO-OWNER
-----------------------------------------------------
Name | DR. DARREN HAMILTON
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 843-276-1979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 35976
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------