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General NPI Number Information
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NPI Number | 1821186461
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Entity Type | Organization
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Legal Business Name | BLACKVILLE HEALTH INVESTORS
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 19354 SOLOMON BLATT AVE N
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City | BLACKVILLE
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State | SC
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Zip | 29817-2304
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Country | US
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Telephone | 803-284-3372
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Fax | 803-284-3372
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Provider Business Mailing Address
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Address Line | 19354 SOLOMON BLATT AVE N
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City | BLACKVILLE
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State | SC
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Zip | 29817-2304
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Country | US
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Telephone | 803-284-3372
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Fax | 803-284-3372
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Authorized Official
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Title or Position | PRES
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Name | MR. KYLE F MCHUGH
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Credential | BS PHARMACY
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Telephone | 803-284-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 14328
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License Number State | SC
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