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General NPI Number Information
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NPI Number | 1972233807
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Entity Type | Organization
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Legal Business Name | PARK CIRCLE PHARMACY, LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 4412 SPRUILL AVE STE C
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-4787
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Country | US
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Telephone | 843-806-1299
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Fax |
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Provider Business Mailing Address
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Address Line | 36 NORVIEW CIR
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City | CHARLESTON
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State | SC
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Zip | 29407-3713
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Country | US
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Telephone | 843-754-8889
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MICHAEL WISE
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Credential |
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Telephone | 843-806-1299
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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 |
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License Number State |
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