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General NPI Number Information
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NPI Number | 1780156596
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Entity Type | Organization
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Legal Business Name | GRAVES FAMILY PHARMACY AND CLINIC
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 1 WINDSOR CV STE 306-2
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City | COLUMBIA
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State | SC
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Zip | 29223-1833
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Country | US
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Telephone | 843-624-3647
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23806
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City | COLUMBIA
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State | SC
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Zip | 29224-3806
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Country | US
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Telephone | 803-624-3647
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CRYSTAL GRAVES
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Credential |
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Telephone | 843-624-3647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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