=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922388081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROMEO SACLOLO ABANGAN JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2011
-----------------------------------------------------
Last Update Date | 12/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 OLD HOUSE RD UNIT 102
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29936-6946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-645-8288
-----------------------------------------------------
Fax | 843-645-8298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4155 WESTERLY LN
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29414-7553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-367-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 13439
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------