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General NPI Number Information
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NPI Number | 1972737229
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Entity Type | Organization
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Legal Business Name | STATE OF SOUTH CAROLINA
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 1751 CALHOUN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2606
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Country | US
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Telephone | 803-898-0813
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Fax | 803-898-0557
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Provider Business Mailing Address
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Address Line | 1751 CALHOUN ST PO BOX 101106
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City | COLUMBIA
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State | SC
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Zip | 29201-2606
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Country | US
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Telephone | 803-898-0813
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Fax | 803-898-0557
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Authorized Official
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Title or Position | DIRECTOR, THIRD PARTY ADMINISTRATIO
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Name | MRS. BETTY H GARREN
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Credential |
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Telephone | 803-898-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 50008287
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License Number State | SC
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