=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972547289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST GEORGE MED CNTR PHCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 RIDGE ST
-----------------------------------------------------
City | SAINT GEORGE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29477-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-636-9130
-----------------------------------------------------
Fax | 843-563-8229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 RIDGE ST
-----------------------------------------------------
City | SAINT GEORGE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29477-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | ARTHUR KENNEDY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 803-531-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 50008540
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------